Chapter 5

The beds Fang Ziye managed himself were 7-9, and the beds his fellow trainee managed were 10-11.

Bed 11 was the last bed for which he revised the medical orders.

After Qin Geluo finished giving instructions, Fang Ziye immediately operated proficiently to open the corresponding medical orders, and also established a Pharmacy Department consultation request in the medical record system.

He quickly recorded in his notebook, needing to write the case record in detail, and after drawing a five-pointed star.

Only then did Fang Ziye say: "Brother Luo, I'll go see the patient first; I'll send you wound photos on WeChat in a bit."

"This Bed 11, the dressing was just changed yesterday, and this morning the wound wasn't even checked."

For elective surgeries in surgery, dressings are changed once every 2-3 days; they don't fuss over the wound checking it every day.

Qin Geluo was completely at ease with Fang Ziye's ward work capability, nodded, and replied with a laugh: "Hey, Brother Qing, it's me, Qin Geluo, Trauma Surgery, need to trouble you to come over and take a look again."

"I have a postoperative patient here..."

There are three forms of requesting a consultation; two are simple procedural forms, namely emergency consultation or routine consultation — just send the request form.

But there is a third form, which is telephone consultation — calling your acquaintances, doctors you have good relations with, to come take a look; it's not an emergency consultation, but it's even better than one, able to solve the problem fastest, and this is when connections matter.

Five minutes later, Fang Ziye had put on a disposable cap and mask, held two culture tubes, had two examination gloves tucked in his pocket, and a dressing kit, and went to find Lan Tianluo.

Lan Tianluo had just finished changing medicine at this moment, and was planning to return the medication cart.

Turning back, looking at Fang Ziye walking over, Lan Tianluo was stunned: "Industry Brother, is there another dressing change?"

A professional master's student in Master's Year Three like Fang Ziye managed only three beds; it was impossible for there to be a bed he didn't know about that needed a dressing change.

"Bed 11, Jie Han's patient, the current situation isn't too good; let's go check the wound condition, estimate there's exudate." Fang Ziye grabbed the medication cart and completed the turn in one motion.

In front of Bed 11.

The patient and family were quite enthusiastic: "Doctor Fang, today you're the one coming to change my dressing?"

Jie Han had previously explained to the patient and family that Fang Ziye was his senior brother, an old hand in the department, while he had only just entered clinical work recently.

It was currently August 10th; Jie Han had not been in the department long. The history-taking and physical examination for Bed 11 were all done by Fang Ziye leading Jie Han, so the patient and family had a natural, greater sense of trust in Fang Ziye.

"Doctor Jie has other matters; I've come to change your dressing." While handing his mobile phone to Lan Tianluo to take photos, Fang Ziye used professional orthopedic bandage scissors to cut off the bandages wrapped on the patient's leg.

On the gauze under the sterile dry cotton pad, he indeed saw light yellow mixed with light red exudate.

Fang Ziye's brow instantly furrowed.

The patient, seeing this, immediately gasped: "How is it bleeding again, Doctor Fang?"

"Have you had strenuous activity these past two days? Has the wound gotten wet?" Fang Ziye asked while lifting the gauze, raising his head, and simultaneously gesturing with one hand for Lan Tianluo to hurry and take photos from all angles.

The gauze lifted, and indeed, at the anteromedial tibial incision, the wound showed slight necrosis!

On the surface of the necrotic wound, there was also a faint pus coating; clearly this infection had come on extremely fiercely!

Fang Ziye hurriedly wiped the pus coating carefully with two cotton swabs, placed them respectively into the two culture tubes, and handed them to Lan Tianluo who had finished taking photos, to tighten the caps.

"How come it's like this? I didn't do anything!"

"Right, no?" The patient, to gain Fang Ziye's trust, looked at her husband.

"No doesn't matter; it's possible it's just a postoperative complication of infection. Postoperative infection is a common thing seen in surgery; don't panic. We're already solving and handling it." Fang Ziye soothed the patient and family's emotions.

Only after taking the specimens did he have the patient move their foot away from the bed, and begin irrigation and disinfection —

First normal saline irrigation, then hydrogen peroxide, povidone-iodine, then normal saline irrigation again until clean, and only then begin using clean cotton balls uncontaminated by povidone-iodine to wipe the wound surface.

One could see the incision edges were slightly swollen...

Inside the suture line, a small amount of pus was still oozing out.

Fang Ziye picked up the hemostat, carefully inserted it into the inner layer of the suture line; because the infected incision showed no healing tendency, inserting it now would not tear local tissue and produce pain sensation.

He inserted inwards about four millimeters or so before Fang Ziye touched bottom; it should be a localized subcutaneous infection, and had not continued deeper.

After cleaning out all the pus, Fang Ziye began disinfection.

Infected wounds require retrograde disinfection from outside to inside; Fang Ziye had mastered these procedures extremely well!

After applying gauze and sterile cotton pad, Fang Ziye then asked: "This wound has an infection tendency; for now, send a culture test first, later see if medication can control it; if not, may need to perform debridement surgery again."

"How could it get infected just like that, out of the blue?"

"Bacteria and microorganisms in the air are everywhere; our hospital's disinfection operations are very standardized, dressing changes also strictly follow procedure; if there's still infection, it might be other reasons, like constitution issues or something else."

"But don't worry, we'll definitely solve the problem, and right now we must first solve the problem, then find the cause..." Fang Ziye explained.

Then pushing the cart, he left...

Naturally, the Pharmacy Department consultation also arrived very quickly, and wrote a consultation form, suggesting to raise the antibiotic level for now, changing from ceftriaxone to piperacillin sodium sulbactam; Fang Ziye followed the advice and revised the medical orders, and also sent a message to Jie Han about this matter, telling him to accompany his aunt to finish the outpatient clinic, then come back...

And, Fang Ziye also told his teacher about this matter, to let Yuan Weihong have a bottom line in his heart; it wasn't snitching, this patient would be known by Yuan Weihong during tomorrow's ward round anyway.

Informing the teacher in advance would let Yuan Weihong properly question Jie Han and figure out the cause.

After all this was finished, Fang Ziye could finally unload the department's matters, and then walked toward the training room.

"Knowledge Points +2!"

When Fang Ziye walked toward Lan Tianluo, he suddenly saw on the panel such a jump.

Fang Ziye was startled in his heart: "How is it this high??"

Fang Ziye carefully pondered the things he had done this morning; it seemed nothing special, just suggesting to his superior physician Qin Geluo that Bed 11 had an infection.

Could it be that diagnosis gives more Knowledge Points > treatment?

Or a more cautious understanding: critical diagnosis outweighs non-critical treatment?

Is this the correct way to open it?

Giving two points of Knowledge Points at once — this is also too shocking!

One hour of operation training is 0.1; twenty hours of concentrated training are needed to get 2 points.

Lan Tianluo was just walking toward Fang Ziye inviting Fang Ziye to go to the training room together.

The Chief Resident of Professor Dong's group, Jin Hongzhou, called out to Fang Ziye first: "Ziye, are you on emergency duty shift today?"

(Chapter End)