I can see the status bar

Chapter 1023 D+3 day (7)

When communicating with the patient's family members, it is necessary to explain in advance that "he is doing well now." This is a new habit that Sun Lien has developed when working in the North Fifth District during this period.

No way, most of the family members of patients infected with the new coronavirus are extremely nervous.If you call without explaining in advance, most of the family members on the other side will directly regard this call as a funeral notice.

Then Sun Li'en had to wear a mask, and tried his best to calm the other party's emotions over the phone.This call takes several 10 minutes to start, which not only wastes time but also wastes energy.

In order to save time, Sun Li'en will cut straight to the point when he calls now, trying his best to completely avoid such a thing from happening.

"Oh, hello, Dr. Sun." There was obviously a mood swing on the other end of the phone, and it was the kind that was stopped before he could feel sad, "Yes...what's the matter?"

"You are Qian Guojian's lover, aren't you?" Sun Lien confirmed the identity of the other party again, and after getting an affirmative answer, Sun Lien said, "After the research by the superior, we decided to give the patient an experimental therapy. Through trust Zhuzumab is used to prevent the imminent immune storm in patients. This drug itself is an old drug used to treat autoimmune diseases, and its safety is relatively reliable. However, because it is applied to patients infected with the new coronavirus Pneumonia patients, so it is beyond the scope of drug use, and we need the consent of the family members for this.”

"Doctor, I'm a liberal arts student. I don't understand what you're saying." The woman on the other end of the phone said, "Is Lao Qian's situation not so good now?"

"It's pretty stable at the moment, but it tends to turn bad." Sun Li'en scratched his thigh - he wanted to scratch his head at first, "He was a little emotional just now, in order to calm him down and cooperate with the treatment, we just gave him He's been on some sedatives. He's looking fine now, but what it's going to be like... I can't vouch for that either."

Sun Lien's words are very sincere. According to the current "evil wind" that patients with severe diseases quickly turn into critically ill patients, and even have their hearts stop beating as soon as they are intubated, he really can't guarantee that after a few hours, Qian Guojian will still be in the same position as he is now. this state.Even if there is a status bar, he can't predict the direction of the disease.The status bar is at best a reminder of things that have happened in the past and now.For such an advanced function of predicting the future, the status bar really cannot provide it.

However, the status bar cannot provide it, but doctors can make a rough judgment based on experience.Judging from the current situation, Qian Guojian definitely belongs to the high-risk group.

He was only diagnosed as high-risk Grade III high-risk hypertension last year. He has a history of smoking for more than ten years, and he is a male—this increases Qian Guojian's risk by several orders of magnitude.

The new coronavirus will attack cells containing AEC2 receptors that control the lowering of blood pressure. Patients infected with the new coronavirus have a high probability of having high blood pressure.Such high blood pressure combined with the patient's primary high blood pressure is basically a near-death situation.

And since he was admitted to the hospital yesterday, the level of interleukin-6 in his body soared from 35 to 77 in one day.At the same time, the absolute count of his peripheral blood lymphocytes has fallen below 0.7 and is still declining.The last blood test was two hours ago, and his peripheral blood lymphocytes had dropped to a level of 0.67.

According to experience, Qian Guojian's situation is very dangerous.Pneumonia patients infected by the new coronavirus deteriorate very quickly, and often remain in a similar state for more than ten days after the onset of illness—people are uncomfortable, blood oxygen levels are relatively low, blood pressure is high and heart rate is high, but overall it is not very good Danger.

And once the patient has an emergency that needs to be rescued, his physical condition will start to deteriorate rapidly.Then began to fall into ARDS (respiratory distress syndrome) and more fatal systemic organ damage.

If the eldest brother hadn't suddenly slapped himself today, maybe he can observe his situation for another two days.But after a toss, Sun Li'en was really worried about his situation.If this continues, who knows which will kill Qian Guojian first, ARDS or cerebral hemorrhage caused by high blood pressure?

"As I said just now, I'm a liberal arts student, and I don't understand medical problems." Qian Guojian's wife on the other end of the phone asked calmly, "Based on Dr. Sun's judgment, give him this old medicine now." The newly used monoclonal antibody should have more advantages than disadvantages, right?"

"Yes." It's easy to talk to smart people, Sun Lien nodded on the phone, "But I still have to remind you that we don't know enough about the new coronavirus. Although there is some evidence that controlling patients The level of interleukin-6 has certain benefits, but this benefit may not be the most immediate kind for patients infected with the new coronavirus..."

"That's better than doing nothing." Qian Guojian's wife said very calmly, "I agree to give Lao Qian medicine. Do you need me to sign now?"

"You probably can't come in here. I've already recorded the phone calls here." Sun Lien said in a deep voice, "Are you sure you agree?"

"Yes, I agree to use this monoclonal antibody on Qian Guojian." Qian Guojian's wife said after a pause for a few seconds, "Dr. Sun, my child has lost his grandmother and grandfather since December last year. And grandma. She is in a very bad state of mind now, and she has nightmares almost every day. I also have a fever recently... Dr. Sun, I dare not think that if in a few days, my daughter finds out that she has lost her parents What's it like?"

Sun Li'en suddenly felt his heart tighten.

"I just received a call from the community, and they are coming to do nucleic acid for me." The woman's voice was still very calm and calm, as if she was talking about today's vegetable prices, "I'm worried that I won't have a chance in two days. Answer the phone—Doctor Sun, is this call still being recorded?"

"Yes..." Sun Lien replied with difficulty.

"I authorize you to do any type of examination, treatment and even surgery for my husband. As long as you think it is necessary, I authorize everything." Speaking of this, the voice of this woman who seemed to be afraid of nothing trembled for the first time, "I just Please save him, my child...my child is only nine years old, the shock of her parents dying within a month...she can't bear it..."

Before the voice finished, the other end of the phone had already started to choke.

"I'm not afraid of death, I'm just afraid that she won't be taken care of in the future..." When referring to her child, this fearless mother suddenly became the most timid child, and her choking gradually turned into crying Howling, "I don't know what to do, I can't do anything..."

Sun Lien's hand holding the phone gradually tightened, and then slowly loosened.After comforting this remarkable woman, he said in a deep voice, "Please rest assured, we will do our best to treat Qian Guojian."

As a doctor, Sun Lien can give little comfort to the family members of the patients, but he is still trying to comfort the compatriots who have never met on the phone, "Our understanding of this virus is gradually deepening, and many people have no way to do it now." There may be a better solution in a week or two to deal with the symptoms. The medicine we are going to give Qian Guojian now is to help him get through these few weeks-he still has hope, you must not Despair, it's not time to despair yet!"

"We will do our best to treat him, and you must persevere." Sun Lien said seriously on the phone, "A nine-year-old child cannot live without his father, nor can he lose his mother. Please persevere!"

After hanging up the phone, Sun Li'en stood up from the chair.Since coming to Yunhe, in addition to feeling fatigue, Sun Lien’s main feeling is depression and negative energy-so many patients, but almost none of them can be rescued, which is a huge challenge to every doctor’s enthusiasm and self-confidence. blow.Although he was still working hard, Sun Lien could clearly feel that his condition was not very good.

Putting on the protective suit every day, he felt more like he was performing end-of-life care for these patients more like a routine than active treatment.While he did do everything he could, it felt like he was in hospice.

But now, Sun Li'en seemed to wake up from this nightmare suddenly.He suddenly realized how important what he did was to patients and their families.

He was saving his lover for a fearless mother, and saving her father for a nine-year-old girl.

He and this medical team came to Yunhe for the life and health of the people, and to save family members, lovers, and loved ones one after another.

Sun Li'en patted his thigh twice violently.The burning pain in his hand lifted his spirits.Health is the key to life, how dare you not do your best?
"Do a chest B-ultrasound on bed 11 to see the area of ​​edema." Sun Lien walked out of the office quickly. He wanted to fight this damn virus head-on. "Calculate the patient's intake and output, and push CRRT over!" He suddenly After a pause, he continued, "Prescribe 11mg of tocilizumab to bed 400, dilute it with 100ml of normal saline, and then infuse it intravenously—the infusion time should be controlled to more than one hour."

"Doctor Sun, the family members agreed, right?" Director Jiang Qingmin of the Department of Endocrinology came over, looked at Sun Lien and said, "Is it a little too radical to give such a large dose of tocilizumab?"

Sun Lien decided to use the dose of 400mg tocilizumab mainly due to two considerations - first, the upper limit dose of tocilizumab recommended for a single injection is 800mg; second, Qian Guojian's neutrophil ratio index is not Great, it is currently around 55%, which is also in line with the indicator for reducing the dose of tocilizumab.Because of this, Sun Lien decided to use 400mg tocilizumab, instead of giving 75mg per kilogram, which is a total of 8mg tocilizumab, according to Qian Guojian's weight of 600 kg.

Generally speaking, the rise of IL-6 in the patient's body will rapidly stimulate the release of neutrophils from the bone marrow.A large number of neutrophils can cause an immune storm, but on the other hand, it can also reduce the risk of nosocomial infection and infection of opportunistic pathogens in patients.

After using tocilizumab, the increase of IL-6 will be curbed immediately, but this also means that the risk of Qian Guojian's infection will further increase.

Severe infection is an absolute taboo for using tocilizumab, which is why Director Jiang asked such a question—Northern Fifth District is transformed from a traditional infectious disease area.The elimination work here is difficult and the effect is not good. The patient's neutrophils are only 55%. If tocilizumab is used later, his risk of infection will be very high.

"Director Jiang, I don't think there is any problem with the usage of 400mg." Sun Lien shook his head and said, "Only living people need to worry about being infected. Once the inflammatory storm rises, the medicine will be useless."

"I understand the truth." Director Jiang agreed, but still insisted on his opinion, "but the risk of this dose is too high - he is not alone in the clean room for treatment. At least give him some c-ball ?”

"Then add gamma globulin... to 20 grams a day." Sun Lien decided after a moment of pondering, "Tocilizumab, gamma globulin and CRRT should be taken together, and I must suppress his immune storm!"

　The "tocilizumab, gamma ball, CRRT" triple therapy mentioned in this article comes from the pioneering work of the Hubei National Medical Team from the Second Affiliated Hospital of Xi'an Jiaotong University in the severe isolation ward of the Sino-French Xincheng Campus of Tongji Hospital of Huazhong University of Science and Technology.

　　
　
(End of this chapter)