I remember some time ago I wrote the article “Do you need infusion” about a letter to the old man’s medical process, and in the following two months I have encountered a number of patients who also in the case of ineffective infusion, after giving the correct treatment, the symptoms quickly improved. I was impressed by a young man in his 20s who had been seen for 5 days with fever and cough, and had previously received a continuous infusion of “cefminox injection” for five days at a local hospital without any improvement in his symptoms. ), the result found that CRP is greater than 160mg/L, I said to him: “You’d better do a CT lung examination.” ? Patient: “Why do I need to do this test?” Doctor: “Usually a fever of more than three days as well as a significant elevation of CRP in the blood are indicative of bacterial inflammation, and you have a cough, so I considered pneumonia, and since there was no significant rales on auscultation, I considered the location of the lesion to be in the back of the lower lung, so a chest X-ray might not detect it, so I suggested a CT lung examination.” Patient: Later examination revealed a solid shadow at the location of the posterior basal segment of the left lower lung, diagnosed as pneumonia, and then this patient took the initiative to ask me, “Dr. Shen, do I need an infusion?” Doctor: “In my opinion, you don’t need an infusion, you just need to take oral antibiotics.” When I saw his puzzled expression, I told him in a positive tone, “Trust me, you will get well soon, remember! Use the right medicine, not the expensive one, and you don’t have to take an infusion to get better.” Of course, usually I rarely vouch for my patients, after all, anything can happen in medicine, and if the patient’s temperature does not return to normal in two days, will I be complained by this patient or vote with my feet to find another doctor and ask for an infusion to go. I instructed him to come for a review in six days, but after six days he didn’t come, and I was worried for a while that something had happened. But on Sunday, the patient came for a review, and as soon as he saw me, he said, “Dr. Shen, what kind of miracle medicine is this? Why were you so sure that I should have a CT lung test to diagnose pneumonia?” Doctor: “In fact, there are rules for diagnosing a disease, for example, the main clinical manifestations of pneumonia are fever, cough, sputum, chest pain in order of appearance, and usually fever for more than three days should be considered bacterial inflammation, and of course, combined with the blood C-reactive protein index for comprehensive consideration.” Patient: “I’ve had blood tests before, but weren’t the white blood cells not high?” Doctor: “Now the accuracy of determining whether there is a bacterial infection by whether the white blood cells are elevated is very low, at present we mainly judge by blood CRP, the advantages are two, the degree of elevation of this indicator is largely related to the degree of infection, secondly, the price is not high, very suitable for clinical work. Usually after the bacteria infect the body its metabolites such as endotoxin and cell wall components enter the bloodstream and are recognized by the body’s immune system, producing various metabolic responses, such as the liver’s mass production of C-reactive protein, which can bind to the cell walls of many bacteria and later bind to the complementary rest to direct the killing of bacteria. This response is non-specific, i.e. it is elevated regardless of the type of bacteria, and can serve as a low level of protection. It may serve to control the bacterial population early in the infection.” Patient: “Which C-reactive protein is elevated is it always a bacterial infection? Can viral infections be elevated as well?” Doctor: “It is true that the reference range varies from hospital to hospital due to different testing methods. For example, the reference range in our hospital is 0~8mg/L, often some patients with fever have CRP of 10~20mg/L, which may be a viral infection or a bacterial infection of a very mild degree, but also in rare cases in the early stage of the disease. How to determine it disease early, if the patient this morning appeared fever, immediately to the hospital to see, a check blood CRP 20mg / L, it is possible that the disease is early, so to review after two or three days. And you have been feverish for five days, if it is a bacterial infection CRP must have risen to more than 100mg/L at once, so when I saw the results of your blood CRP I considered the site of infection.” Patient: “Then why is the change in leukocytes during infection not as good as CRP?” Doctor: “In the past, we used to use the increase in leukocytes as an important indicator to determine infection during school and practice, but in the process of clinical practice, we found that this indicator has the problem of low accuracy, for example, for For example, for pregnant women, we found that their leukocyte level is usually higher than that of the general population, and may be greater than 10*109/L even without symptoms, so the best way to determine whether a patient is infected is CRP, in addition to medical history, fever, and pus-producing sputum. The patient: “Is there a better indicator to determine or distinguish between viral and bacterial infections? Doctor: “Of course, there are methods, but they are not very cost-effective, such as the measurement of neutral alkaline phosphatase on blood smears, but because of the time-consuming procedures, they are generally only considered in cases where the diagnosis is unclear in hospitalized patients. Another measurement called serum pre-calcitoninogen, which is currently performed in some large hospitals, may help distinguish between upper and lower respiratory tract infections, which are generally viral-based and bacterial-based, so elevated pre-calcitoninogen can help distinguish between viral and bacterial infections.” Patient: “So does an elevated crp always mean there is an infection?” Doctor: “That’s not exactly true. Since crp is highly sensitive but not highly specific, it can be elevated in many cases, such as patients with myocardial infarction, fractures, and stress, so to determine its value it must be combined with medical history. For outpatients, however, these issues are not considered in cases like yours.” Patient: “And does pneumonia always require an infusion?” Doctor: “In your case, for example, I know you’re worried about whether you can control it with oral medicine alone. Since infusion was commonly used to treat pneumonia in the past, many of us people have this impression that hanging saline must be better than oral medicine, but it’s not. I once heard of a case where a lady went to the hospital with a cough, phlegm, fever, and no effect of cold medicine. Of course, this kind of thing rarely happens, but once it happens very dangerous, after all, the drug into the blood vessels to react is very fast, and oral drugs have to be absorbed through the gastrointestinal tract, liver metabolism these detoxification, the danger is relatively small.” Patient: “Okay, I’ll listen to you. So I also want to ask how long do I have to take the drugs orally?” The actual fact is that you will be able to get a lot more than just a couple of days to get a lot more than just a couple of days. The actual fact is that you can find a lot of people who are not able to get a good deal on a lot of things. Usually the body is okay, then the antibiotic course is usually three days after the body temperature is completely normal, or blood CRP down to about 30mg/L.”