Dermatology is considered a famous department of the first hospital. Although the number of people cannot be compared with the top three dermatology majors in Minghai, Shangjing, the chief director Kong Qiong is very strong and has also brought together many dermatology talents in Danyang.

The purpose of the First Hospital is to compete with Danyang Hospital, and when competition is not possible, it will complement each other.

The dermatology and dentistry department of Danyang Hospital are not strong. There are only about 30 beds in the dermatology department, and only more than 20 medical staff are placed in one piece. The dentistry department has only a few outpatient treatment rooms, and there is not even a bed. As a complementary hospital, the first hospital has strongly supported these two departments. A few years ago, a joint dermatology inpatient building was built in the hospital and separated them separately.

This building is actually not high, only six floors, but it has already greatly tilted funds for the size of the marginal departments of these two comprehensive hospitals.

Compared with the inpatient department of the internal medicine department, the dermatology building is much closer to the surgical building.

This also coincidentally made Kong Qiong and Director Lu Xiaoyan of the Respiratory Department meet their heads in advance.

The two were old employees of the First Hospital and greeted each other. However, they waited for the elevator of the surgical building together and asked each other, and found out that the other party was also going to orthopedics.

"What's the situation with this patient in orthopedics?" Kong Qiong was confused by Li Xin's phone call anyway. "It's both respiratory tract and skin, and finally it's drilled into the bones. Why does it sound so much like tuberculosis?"

"I thought it was tuberculosis at first," Lu Xiaoyan said with a smile, "but the young doctor in the orthopedic department said that no tuberculosis lesions were found."

“Some tuberculosis is hidden.”

"Yes, but the isoniazid and rifampicin used for tuberculosis treatment have no effect on patients, but the side effects are very large."

“How long has it been used?”

"I heard it's been more than twenty days."

"It's not effective for so long. Is it drug-resistant tuberculosis?"

"It is very rare to have both drugs resistant, and they only develop resistance after taking these two drugs for a long time. I have never seen a natural drug resistance."

"Let's go and have a look first..."

The two of them entered the orthopedic ward with tuberculosis-related problems in their minds, but after entering the office, they suddenly found that the case discussion was very complete. On the white record board, several lines of varying lengths outlined the complete development of the disease, and many suspected causes were written on the side. From hormones, trauma to various infections, drug-resistant tuberculosis is listed.

However, the young man on the stage had already ruthlessly drawn on the fork.

However, the scale and content of the discussion were far beyond their expectations.

Since you are a complicated patient, you naturally have to participate in the discussion and express your opinions. The department head usually sits aside and learns from others and finally makes up your mind.

But now, the chief director who should have planned to make plans rushed forward and kept making output. The battle situation was extremely stalemate. Even after seeing the two chief directors in, Xie Zongpei just nodded slightly, turned around and argued again. Looking at the backbone of the backbone of the department, he was sitting leisurely on the wall.

But the one who was strolling against this chief was a young man.

Lu Xiaoyan finds it novel:

Kong Qiong sighed and couldn't help laughing:

Kong Qiong originally wanted to use a word to describe Qi Jing, but what jumped into her mind was derogatory words such as "everyone is in the world" and "the ghost is not dispersed". It was really indecent to say it directly. She hesitated for a moment and changed the statement:

Kong Qiong nodded gently.

Lu Xiaoyan looked at Qi Jing and couldn't help asking again,

Kong Qiong couldn't help but sigh again,

Lu Xiaoyan didn't know what to say,

Kong Qiong wanted to try his best to avoid that big consultation. After all, it was not a happy thing for a bunch of old experts and directors to hear a resident talk on the stage.

Unfortunately, it is easy to avoid people and difficult to avoid things, and the content of the two people's discussions once again exceeded their expectations.

There is no tuberculosis at all, let alone drug resistance. Here, noka and non-tuberculosis are the mainstream. Actinomycetes of Noka are also known to non-tuberculosis Mycobacterium in the knowledge scope of their two people, but it seems embarrassing to subdivide it down.

Kansas, bird-intracellular, turtle and turtle subtype, land, occasional, secondary, Geneva, ape, sea, bloodthirsty, gordon, ulcer, toad...

From the suffix "Mycobacterium", it is not difficult for them to guess that these are non-tuberculous mycobacteriums. But just knowing that these are useless, you must also know their contagious routes, the symptoms of the disease caused by the infection, the various drugs to fight them, and the prognosis.

There are too many categories of non-tuberculosis Mycobacterium, and even ordinary clinicians are not very good at remembering these rare opportunity pathogenic bacteria. That is, those big guys with solid foundation have the spare time to learn these remote knowledge.

In fact, Kong Qiong and Lu Xiaoyan are both strong.

As a master of the department, they will naturally pay attention to this knowledge and must have an understanding of non-tuberculous mycobacterium. If they sit down and think about it slowly and analyze it slowly, their performance will not be much worse than Qi Jing.

But because of the different depths of memory and the unforgiving years, the two of them have no reactions to Qi Jing at all.

If we follow the common medical case ideas, first check and then confirm the diagnosis and finally treat it, there will be no gap between them and Qi Jing.

But Qi Jing’s idea is different from theirs: “The chest radiograph has been urgently done, but I still recommend a whole-body CT scan. If bone damage, arthritis or clear infection lesions in the lungs are found, then the diagnosis can be made.”

"You can use phlegm and culture pharyngeal swab to send it to the Centers for Disease Control and Prevention."

"The CDC is too slow to produce results."

Because of the high-intensity lineup with Xie Zongpei, Qi Jing is now in a highly excited state, and the radical clinical thinking of the past slowly surfaced: "In fact, we can do diagnostic treatments."

"Is the diagnostic treatment too radical?" Lu Xiaoyan suggested, "This patient is not a critically ill patient, the infection is not serious, so you can wait."

"Yes, the non-tuberculous mycobacterium is not highly toxic and cannot be compared with tuberculosis at all." Kong Qiong also felt that the treatment could be postponed. "It is better to let the orthopedics see if there are any indications for surgery. After all, the patient's fracture of the vertebrae is seriously damaged, and the more he drags, the more trouble it becomes."

Xie Zongpei nodded and agreed.

Although I have never seen a patient with bone infection of non-tuberculous M. tuberculosis and non-tuberculosis are both included in the Mycobacterium category, and the treatment method of bone tuberculosis can be completely clinically referenced. At this time, he needs to slowly replace the infectious disease knowledge of Nokaria and Mycobacterium that are still rampant in his brain with surgical knowledge of bone tuberculosis.

This was actually a very short process, but Qi Jing didn't give him any time to react.

"Director Kong, in this case orthopedic surgery should not be able to operate." Qi Jing said, "regardless of whether the patient has an infection or not, as long as there is a suspected infection of non-Medobacterium tuberculosis, anti-infection treatment is required before the operation. It will take at least two weeks until the infection is controlled."

His brain thinking was still slower, so Xie Zongpei could only watch Qi Jing steal his words, without any help.

Kong Qiong did not expect that the surgical indication was stuck so much in the bone infection. Looking at Xie Zongpei, he had to nod and agree after hearing this. This is how bone tuberculosis is treated. No matter how anti-tuberculosis treatment is performed first, and the surgery can only be done after physical conditions allow it.

"Director Xie also thinks that internal medicine should be treated first?"

Xie Zongpei nodded again: "This is the way to deal with tuberculosis."

"Does the surgery need to be performed after the CDC report?"

"If it is really Mycobacterium tuberculosis... the answer is yes."

"Since Director Xie has said that, let's discuss diagnostic treatment directly."

Qi Jing ignored the large part of the differential diagnosis process in the middle and attributed Wang Pingshi's cause to non-tuberculous mycobacterium: "Start with Kansas, it is also a member of the more common non-tuberculous mycobacterium. It should have been isoniazid rifampicine butamol, but the first two resistances have to be changed..."

The three senior directors were just stuck for a while, and when they reacted, they found that their thinking was a little unrestrained.

Qi Jing only took a few seconds to jump from the Centers for Disease Control and Prevention to the treatment plan for Mycobacterium Kansas. Once his thoughts did not follow Qi Jing, he would find that he could not understand anything when he listened.

"We can choose a combination of vitamin B6 compound sulfamethoxazole, which has a good effect in the treatment of Mycobacterium Kansas."

"Wait...this compound sulfamethalate..."

“Methoxazole.”

“Yes, what medicine is methoxazole?”

"Oh, it is a compound preparation of sulfamethoxazole and trimethoprim. The product name is compound Xinnuoming, a sulfa antibacterial drug."

A spiritual question from an inconspicuous little doctor in the audience made the three chief directors breathe.

However, Qi Jing continued, without any intention of stopping: "Apart from Kansas, my best opinion is the bird-intracellular complex Mycobacterium. Because the patient's chest x-ray showed that there was a small nodule on the chest x-ray a few years ago, and there was a manifestation of the lung infection caused by this bacteria.

Xie Zongpei had already argued and sorted out Wang Pingshi's medical records. After a while, he took out the film report and handed it to the two senior directors around him: "I did it in the outpatient clinic of the Third Hospital in May 1996."

Lu Xiaoyan looked at the report and said, "There are only three nodules in total, each of which does not exceed 3mm, which seems to be nothing."

“It is indeed a little smaller in quantity and volume.”

"This evidence is not specific, and in many cases it is possible to produce small nodules." Xie Zongpei finally found a loophole, successfully won the game, and got the dominant voice back, "I think it's better to take a look at the chest x-ray."

After saying that, he looked at Li Xin, who nodded and ran to make a phone call.

A chest x-ray examination form written by Xie Zongpei, the size of it goes without saying. Moreover, before Wang Pingshi arrived at the X-ray room, Li Xin had already called and took care of it for a few words. It was difficult to get the whole examination speed.

The phone is set to hands-free mode.

"Director Liu, has the patient's chest x-ray been completed?" Li Xin asked with a smile.

"Just finished." Director Liu said with a smile, "You orthopedics are too anxious. It's not counting if I asked me, a director of the imaging department, to take care of the patients. Do you still want to supervise me to read the film now?"

"Haha, Lao Liu, you are joking again." Xie Zongpei took Li Xin's words at this time and asked, "Is there any problem with the patient?"

"There are some problems, but they shouldn't be big." Director Liu paused at the images appearing on the computer and continued, "There are only four or five small nodules and a few small holes, which look like some kind of chronic infection, but it should be considered a semi-healing state."

"Is it tuberculosis?" Li Xin asked again.

"Not like it, probably not."

"Can you tell what the infection is?"

"It's difficult, I'm not too professional in terms of infection..."

After the conversation came here, there was actually not much information available. It was just that the number of nodules increased from 3 to 5, and some small nodules had changed into hollows before. However, the other party did not explain clearly the degree of infection and the type of infection.

Qi Jing felt that it was meaningless to make a fuss on both lungs, so he ran to the phone and leaned over and asked, "Can you see the patient's bones?"

Director Liu was stunned. The orthopedics changed? Why did anyone dare to rob Xie Zongpei of the words? However, this sentence reminded him that while looking at the chest x-ray, you can also check the bone condition.

"Bone damage...rib...clarbone...scapula...scapula...shoulder joint...sternum...thoracic vertebra..." Director Liu glanced back and forth a few times and replied, "No, no imaging changes in bone damage were seen."

No bone damage?

Qi Jing's diagnosis basis is multiple infections at three sites, starting from the respiratory tract to enter the subcutaneous tissue and bones, and the bones are likely to be the final station. But now no bone damage is found, so there is much less evidence supporting Mycobacterium non-tuberculosis.

wrong!

Qi Jing changed his tone and continued to ask: "Is that patient gone?"

"Patient?" Director Liu looked at Wang Pingshi who had just lying back on the hospital bed and said, "I haven't left yet, what's wrong?"

"Please ask Director Liu to take a few more films for him." Qi Jing said with a smile, "If you take the position, take the right and lateral film of the limbs."

"Lips?"

"Yes, just look for bone damage." Qi Jing seemed to think of something again after saying that, adding, "Director Liu, the x-ray here can be transmitted to the local area network. Can we see it here?"

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Chapter completed!