Fang Ziye was responsible for beds 7-9, while his junior apprentice was in charge of beds 10-11.
Bed 11 was the last one where he had to modify the medical orders.
After Qin Geluo gave his instructions, Fang Ziye immediately and skillfully entered the corresponding medical orders and created a consultation request form for the pharmacy department in the medical record system.
Quickly jotting down notes in his notebook, needing to write a detailed case report and mark it with a star[1], Fang Ziye then said, "Brother Luo, I'll go check on the patient first. I'll send you photos of the wound site on WeChat later."
"This patient in bed 11 just had their dressing changed yesterday, so we didn't check the wound this morning."
For elective surgeries in the department of surgery, dressings are changed every 2-3 days to avoid disturbing the wound too frequently.
Qin Geluo had complete faith in Fang Ziye's ward management skills. He nodded and then said with a smile, "Hey, Brother Qing, it's me, Qin Geluo from the trauma surgery department. I need to trouble you to come take a look again."
"I have a post-operative patient here..."
There are three forms of consultation requests. Two are simple procedural forms: urgent consultation or regular consultation, where you just need to submit the application form.
But there's a third form, which is a phone consultation. This involves asking a familiar doctor, someone you have a good relationship with, to come and take a look. It's not an urgent consultation, but it's treated as one, able to solve problems quickly. This is when having a good network of connections comes in handy.
...
Five minutes later, Fang Ziye had put on a disposable cap and mask, grabbed two culture tubes, stuffed two examination gloves in his pocket along with a dressing change package, and went to find Lan Tianluo.
Lan Tianluo had just finished changing a dressing and was about to return the dressing cart when he turned and saw Fang Ziye approaching. He was surprised: "Brother Ye, are there more dressings to change?"
As a third-year professional master's student, Fang Ziye was only responsible for three beds, so there shouldn't be any beds needing dressing changes that Lan Tianluo didn't know about.
"Bed 11, the patient under Jie Han's care. The current situation isn't good. Let's go check the wound condition. There's likely some exudate," Fang Ziye said as he grabbed the dressing cart and turned it around.
At bed 11, the patient and family were quite friendly: "Dr. Fang, you're changing my dressing today?"
Earlier, Jie Han had explained to the patient and family that Fang Ziye was his senior apprentice brother and an experienced member of the department, while he himself had just recently started clinical work.
It was only August 10th, and Jie Han had just joined the department. The initial inquiry and physical examination for bed 11 were done by Fang Ziye with Jie Han assisting, so the patient and family naturally trusted Fang Ziye more.
"Dr. Jie has other matters to attend to, so I've come to change your dressing," Fang Ziye said as he handed his phone to Lan Tianluo to take photos. He used professional orthopedic bandage scissors to cut off the bandage on the patient's leg.
Sure enough, under the sterile dry cotton pad, there was pale yellow mixed with light red exudate on the gauze.
Fang Ziye's brow furrowed instantly.
The patient looked and immediately became alarmed: "Dr. Fang, why is it still bleeding?"
"Have you had any strenuous activity in the past two days? Has the wound gotten wet at all?" Fang Ziye asked as he lifted the gauze, while gesturing to Lan Tianluo to quickly take photos from various angles.
With the gauze removed, they could see that the incision on the medial side of the tibia showed signs of mild necrosis!
The surface of the necrotic wound also had a faint purulent coating, clearly indicating that the infection had come on quite aggressively!
Fang Ziye quickly and carefully used two cotton swabs to wipe the purulent material and placed them into two culture tubes, which he then handed to Lan Tianluo, who had finished taking photos, to tighten the lids.
"How did this happen? I didn't do anything!" the patient exclaimed.
"I didn't, right?" the patient looked to her husband, seeking to gain Fang Ziye's trust.
"It's okay if you didn't do anything. Post-operative infections are common in surgery. Don't worry, we're already addressing and treating it," Fang Ziye reassured the patient and family.
After collecting the samples, he had the patient extend their foot away from the bed and began washing and disinfecting the wound—
First with saline solution, then hydrogen peroxide, followed by povidone-iodine, and finally rinsing clean with saline solution again before using clean cotton balls not contaminated with povidone-iodine to wipe the wound surface.
The edges of the incision could be seen to be slightly swollen...
Within the suture line, there was still a small amount of purulent fluid seeping out.
Fang Ziye picked up a hemostat and carefully inserted it into the inner layer of the suture line. Due to the infection, the incision had not shown signs of healing, so inserting the instrument at this point would not cause pain by breaking local tissue.
He inserted it about four millimeters before reaching the bottom, indicating that it was likely a localized subcutaneous infection that had not progressed deeper.
After clearing away all the purulent white material, Fang Ziye began disinfecting.
Infected wounds need to be disinfected in reverse order from outside to inside, a procedure Fang Ziye had mastered extremely well!
After applying gauze and a sterile cotton pad, Fang Ziye asked again: "Your wound shows signs of infection. For now, we'll send a culture for examination. We'll see if we can control it with medication later. If not, we might need to perform another debridement surgery."
"How could it get infected out of nowhere like this?" the patient's family asked.
"Bacteria and microorganisms are everywhere in the air. Our hospital's disinfection procedures are very standardized, and we change dressings strictly according to protocol. If there's still an infection, it might be due to other reasons, such as individual constitution or something else," Fang Ziye explained.
"But don't worry, we'll definitely solve the problem. Right now, we need to address the issue first, and then we'll look for the cause..."
Then he pushed the cart away...
Naturally, the pharmacy department's consultation arrived quickly, and they wrote up a consultation form recommending upgrading the antibiotic level from cefuroxime to piperacillin-tazobactam. Fang Ziye followed the instructions to modify the medical orders and sent a message to Jie Han, asking him to come back after accompanying his aunt to her outpatient appointment...
Moreover, Fang Ziye also informed his teacher, Yuan Weihong, about this matter, not to tattle, but to give him a heads-up. Yuan Weihong would inevitably find out about this patient during tomorrow's rounds.
Informing the teacher in advance would allow Yuan Weihong to question Jie Han thoroughly and clarify the cause.
After finishing all of this, Fang Ziye could finally set aside his departmental duties and head to the training room.
[Knowledge Points +2!]
As Fang Ziye walked towards Lan Tianluo, he suddenly saw this message flash on his status panel.
Fang Ziye was startled: "Why so much?"
He carefully thought back on what he had done that morning, but nothing seemed out of the ordinary. He had only suggested to his superior, Dr. Qin Geluo, that the patient in bed 11 might have an infection.
Could it be that diagnosis yields more Knowledge Points than treatment?
Or to interpret it more cautiously, critical diagnoses are worth more than non-critical treatments?
Is this the correct way to approach things?
Giving two Knowledge Points at once seemed a bit too shocking!
One hour of operational training was worth 0.1 points, so it would take twenty hours of intensive training to earn 2 points.
As Lan Tianluo was walking towards Fang Ziye to invite him to the training room together, the chief resident from Professor Dong's team, Jin Hongzhou, called out to Fang Ziye: "Ziye, are you on emergency duty today?"
Translation Notes:
[1] Mark it as important information.