A question from Sun Lien triggered a heated discussion in the entire medical team. Liu Tangchun was indeed a little shocked when he looked at himself, a mysterious student who was smiling. There was no problem with Sun Lien's inference, and his question exposed the most core doubts directly in front of everyone.

Liu Tangchun narrowed his eyes, but his heart was turning backwards, thinking about when Sun Lien discovered something wrong with the diagnosis direction - even Liu Tangchun himself had all the examination reports of the patients he had just seen. Comrade Liu was extremely sure that Sun Lien must have had his own ideas first, and then he would say this at the meeting.

As for Sun Lien... he was still keeping a polite smile on his face, but he kept muttering in his heart, "No way? No way?"

I just asked casually according to my own ideas. Don’t you think you have seen through the answer?

As a doctor who just obtained a medical certificate, Sun Lien is used to treating all doctors' diagnosis as "correct" diagnosis. If a French doctor believes that the patient has meningococcal infection, he must have seen some strong evidence that can support this judgment. Although the test proves that the French doctor misdiagnosed it. That evidence is likely to be the core evidence that guides the entire diagnosis process.

As for the cultivation of calcified bacteria and anaerobic bacteria, this is the lesson Sun Lien learned in the Fourth Hospital. For example, the infection of the yellow-haired dog-biting carbon fibromyces has never been clearly defined through bacterial culture. There will be no errors in the status bar. If it cannot be cultured, it must be a problem during the cultivation or sampling. After investigating the literature, Sun Lien decided not to blame his roommate Shi Yan for his skilled skills - most of the infections of the dog-biting carbon fibromyces are clearly identified through the MNGS examination.

Suppose, if the situation of this female patient really matches the direction other doctors guess, then the problem that really tests the doctors is about to come - how to treat some unknown source of infection based on uncertainty of the type of infection of the patient?

"If Dr. Sun's guess is not wrong, if our inference is correct," the physician said after discussing with several doctors around him. "Then first of all, we can basically be sure that ceftriaxone is not effective in this infection. In other words, this bacteria is resistant to β-lactam antibiotics."

"I tend to resist drugs." Liu Tangchun added, "The patient's condition develops too fast. If it is drug resistance, at least one process should be in which the condition gradually rises to the pre-treatment state and then worsens. Three days after admission, it is unconscious and has high intracranial pressure, which is more like the condition is covered up by ibuprofen."

"That is, there are two possibilities for this bacteria we need to deal with." The physician nodded and continued to analyze, "It may be a type that can secrete beta-lactamase, can hydrolyze antibiotics or have a restraining mechanism to hinder antibiotics from entering the target site. As for pbps target protein mutation and cell wall permeability changes, these two are mainly drug resistance rather than drug resistance."

"The next question is, what bacteria can secrete beta-lactamase, and which ones can pass through the cerebrovascular barrier and lead to meningitis." Liu Tangchun nodded, and he once again pointed Sun Lien's name, "Tell me, what do you think?"

It was Sun Lien's turn to call him this time, "I...I don't know either." Sun Lien shook his head apologized, "I just have this idea now. For specifics... I still have to look at the test data." He suggested carefully, "But even if you don't know what bacteria it is, you can try to treat it, right?"

In fact, according to Sun Lien's idea, it is basically impossible to determine the type of bacteria infected before such unknown bacteria that can secrete β-lactamase to kill the patient. This is Africa, not the fourth hospital where MNGS testing can be performed. The patient's condition has worsened to the point of being unconscious three days after admission. If he is still obsessed with bacterial culture, then when the results come out, he can basically sign a death certificate for the patient.

Rather than obsessing with the specific types of bacteria, it is better to use the characteristics it shows to conduct wide-net treatment. Gram-negative bacteria are not sensitive to ceftriaxone, but at least they also have aminoglycoside antibiotics, macrolide antibiotics and quinolones to choose from. You can even use β-lactam antibiotics such as meropenem to anti-β-lactamase.

"For example, use doxycycline and moxifloxacin in combination." Sun Lien proposed his own treatment plan. "Doxycycline has a wide range of antibacterial effects. Moxifloxacin, as a quinolone drug, can also cross the cerebrovascular barrier and combine with brain tissue well."

"The idea is good, but it is unrealistic." Liu Tangchun vetoed Sun Lien's suggestion without hesitation. "We do not reserve moxifloxacin, and she is allergic to the levofloxacin she brings." He looked at the doctor next to him, "How is the patient's liver skill now?"

"It's not too good, but it's not as good as you need to worry." Dr. Shennei took out his cell phone and showed the doctors present a screenshot of the patient's liver function test five hours ago. "The other alanine aminotransferase 84 has increased to varying degrees."

"Considering the patient's high fever, this increase is not a big problem." Liu Tangchun looked at Sun Lien, "For this patient, you can take a look with Dr. Hu. Mainly learn how to use the medicine."

Liu Tangchun had no more opinions on Sun Lien's diagnosis and clinical thinking. Sun Lien's main weakness in these two items is that he lacks experience. Through Dean Wu Youqian's one year of special training, Sun Lien's ability is much stronger than before - at least he can get rid of the students' habit of asking questions like doing questions and focus on solving the patient's disease problems. This made Liu Tangchun even feel a little surprised.

Don’t think that the doctor’s lack of obsession with the patient’s condition is a bad thing. Being able to figure out when you can be confused and when you must be clear is the sign of the maturity of a clinician. Yuan Ping’an was sent to the Fourth Hospital for study because his academic master’s temperament was too distinct. In order to understand the specific development process of a disease, he could check the information for a day. This personality is definitely a good person in academic research, but it is not possible to do this in clinical practice. There is no pause button in daily life. As doctors seek answers, the patient’s disease is also constantly developing. A patient whose disease reaches the end of the disease and even the condition cannot be reversed cannot use the late answer.

As for letting Sun Lien learn from Dr. Hu in the medical team, Lao Liu actually has two meanings. The first is to hope that Sun Lien can have some new experiences in clinical treatment and medication by observing the work of doctors from other medical schools. After all, Sun Lien is still inexperienced in work now, and most of the treatment plans he proposed come from medical textbooks and pharmacopoeia. From Liu Tangchun's perspective, it is safe but not spiritual.
Chapter completed!