I can see the status bar

Chapter 1081 Life is Movement
"Doctor Sun, what is this thing you're wearing on your head?" After returning to the North Fifth District where he had been away for three days, Sun Li'en had not had time to ask the patients how they were doing today, and they were all concerned. .

No way, something like an action camera really doesn't match the protective clothing.In the ward, the small black square fixed on Sun Lien's head with an orange elastic band is too eye-catching.

"This, this is a video camera." Sun Li'en said in the Yunhe accent that he just learned and was not used to and sounded slightly funny, "The reporter from our provincial TV station wants to make a documentary, let me stand up Go to work with this thing and help them shoot some material.”

"That is to say, we are all going to be on TV?" A few younger patients suddenly cheered up, "When will it be broadcast? Can we all be on TV? Oh, I can't even put on makeup. Give me a make-up later, huh?"

The atmosphere in the North Fifth District is much more relaxed. No matter which ward Sun Lien walks into with the camera on, he will be greeted with warm greetings and welcome from everyone—the motion camera on top of his head seems to have taken on other meanings suddenly. It can make these patients who are in pain suddenly cheer up.

They don't want their relatives and friends to see them suffering, and they don't want to show their weakness and pain.So even if you are not feeling well, make yourself look like there is nothing wrong with you.

Even some patients who were lying on the bed and didn't like to move stood up with oxygen inhalation tubes. They waved to Sun Lien, who was holding a camera, and said with purple lips and hoarse voices, "I feel much better. .”

Such a scene is very abnormal. After Sun Lien realized the cause of this change, he once wanted to take off the camera immediately and let the patients lie down and rest.But... He was a little surprised to find that after standing up, although the blood oxygen saturation of several not too heavy patients fluctuated, the peak of pulse oxygen was higher than before lying in bed.

This is a bit strange.Sun Lien frowned and opened the status bar to look at these patients, but in the end he returned without success.He really couldn't find a reason that could explain the sudden improvement of the patient's vital signs.

As a doctor, Sun Li'en has never pinned the patient's changes on some non-objective facts.But this time, he felt that his will was slightly shaken.It can't really be because the camera is very auspicious, so that these patients who should theoretically receive two to three days of treatment before they can stabilize will get better in advance, right?
No, calm down and think about it.Sun Lien tried his best to persuade all the patients not to move around, and to return to the bed and sit for a while to prevent blood pressure changes and falls caused by sudden movements.But he took the opportunity to start thinking again about the relationship between "carrying a camera by himself" and "the patient's finger pulse oxygen has changed and improved slightly".

Not all patients improved, which was the first prerequisite for Sun Lien's analysis.How do patients who improve differ from patients who remain unchanged?It has nothing to do with gender, and it seems to have little to do with the duration of the disease...

What do these patients have in common, and what are the differences?Sun Li'en frowned and thought about it for a long time, but the difference seems...it's really not that big of a difference.

Not all patients who are agitated can get better, at least they have to stand up first...

Thinking of this, Sun Li'en suddenly felt as if he had grasped something important.

The oxygen levels required by the human body at rest and during exercise are different.When lying down and standing, the impact of gravity on the lungs is completely different.And emotional changes will also affect the patient's physiological state... Is it because of this?

Just because they got off the bed, stood on the ground and waved enthusiastically at the camera above their heads?
This answer still seems a bit too ridiculous, but at least it is a little more convincing than "the camera is an auspicious good thing".

For these patients with interstitial pneumonia and sporadic infection of the lungs and sputum plugs, the effect of gravity on the lungs can have a dramatic effect on their breathing.Otherwise, prone position ventilation would not become one of the standard treatments for severe and critically ill patients.

According to Sun Lien's understanding, the phlegm suppository will be affected by gravity and penetrate deeper into the bronchial branches.Although this is not conducive to the patient's expulsion of phlegm plugs, it is possible to let some branches go and let them recover their functions.When standing up, the lungs, diaphragm, and other organs sink under the influence of gravity, leaving more room for the lungs to expand.This also helps the patient's lung volume rise, increasing oxygen exchange.This may be one of the reasons for the improvement in the patient's condition.

Thinking along this line of thought, Sun Li'en suddenly felt that...he and his colleagues in the medical team might have fallen into a misunderstanding.

Previously, in order to alleviate the hypoxemia of critically ill and critically ill patients, doctors tended to keep patients strictly in bed.If necessary, even consider sedating the patient, passively minimizing the body's oxygen consumption levels.This move can stand the verification of facts.Qian Guojian is the best example—at the beginning, because he was emotional and tried hard to fight against Sun Lien's hand, his oxygen consumption suddenly increased, and his body suddenly fell to the verge of collapse.

But... After these agitated patients stood up, their blood oxygen saturation rose a bit.

After standing up, their basal oxygen consumption will definitely increase due to the need to maintain balance.However, the peak of finger pulse oxygen increased by about 2%, which means that the oxygen saturation they actually increased should be greater than 2%, and why?
Sun Lien returned to the red zone office with this confusion and question, and then he shared this question with his team members.

"My personal feeling is that their changes may also be related to emotions." After explaining the general situation, Sun Li'en expressed his conjecture, "But this mechanism... I haven't figured it out yet."

Emotional highs can trigger some physical changes.Such as faster heart rate, higher blood pressure, more dopamine secretion.But Sun Lien was a little skeptical whether this judgment was correct—the resting heart rate of these patients was not too slow, and their heart rate was basically above 95 beats per minute.And most people's systolic blood pressure has exceeded the level of 130mmHg.

In this case, the emotional high will cause the heart rate and blood pressure to rise, and the secretion of dopamine will increase...Will it not further increase their physical burden?
After hearing Sun Lien's confusion, Dr. Ma Yongfang asked in confusion, "Why do you need to figure this out?"

Several other doctors also agreed and nodded in confusion, "This...is it necessary to figure out the mechanism now?"

Sun Lien was confused by everyone's reaction.

"Director Sun, look..." Dr. Ma Yongfang explained, "I used to work in the Department of Endocrinology, you know that?"

Sun Li'en nodded in confusion.

"Metformin is the drug of choice for the treatment of type 50 diabetes, and it is used throughout the course. It has been used in various countries for more than [-] years since it was discovered. It is safe and effective - and we are still In clinical research, its new efficacy is constantly discovered.” Dr. Ma Yongfang said, “However, until now, we have not figured out what the specific mechanism of action of this drug is. But this does not prevent us from prescribing it to patients. Metformin, and encourage them to take it on time and in the right amount.”

"In many cases, we don't need to fully understand the mechanism. We just need to make sure that the benefits of this plan outweigh the risks for patients and that there are no significant risks." Yuan Pingan explained next to him, "Director Sun, you are too nervous. In fact, it’s fine for them to stand up and breathe. There is a simple explanation for this—when standing, affected by gravity, the bronchi in the patient’s body is less stimulated by sputum, the cough is weakened, and breathing is smoother.”

This explanation... seems to make sense.Sun Li'en thought for a while and said, "Why don't we encourage the patient to stand up and move around?"

Getting up and moving a hypoxemic patient is a risky medical decision.But now Sun Li'en suddenly felt... This risk is actually acceptable.

The biggest risk for patients with hypoxemia to stand up is that the increase in oxygen consumption leads to aggravation of hypoxemia.Such changes may cause the patient to lose consciousness within a short period of time and fall and be injured, and over a long period of time may induce MODS (respiratory distress syndrome) and lead to further aggravation of damage to other organs.

But at present, it seems that asking them to stand up and move a little will not immediately cause the blood oxygen saturation to drop, and it may even rise a little bit.This is a very good phenomenon.

Standing up and moving instead of lying in bed all the time, on the one hand, it can increase the blood oxygen saturation in their body, and on the other hand, it can promote the patient's expectoration.

The importance of sputum discharge is much more important than ordinary people imagine. To give the simplest example - the one-year survival rate of femoral head fractures in elderly patients is only 50%.This is not to say that after the fracture of the femoral head in the elderly, there is a high probability of death due to the fracture.The main reason for the great increase in the mortality rate of elderly patients after femoral head fractures is actually the result of inconvenient activities after fractures, so the elderly often suffer from severe lung infections.

Due to limited mobility, older adults tend to prefer bed rest rather than getting up and moving.Prolonged lying down and reduced activity lead to reduced lung ventilation and difficulty in expulsion of sputum.If things go on like this, coupled with the weaker immunity of the elderly themselves, their chances of severe lung infections will soar.

And the activity also helps blood circulation in the legs, reducing the risk of DVT (deep vein thrombosis).All in all, the phrase "life is in motion" isn't something people just made up.

"In this case, how about getting something like a walker?" Zhou Ce thought for a while, and then suggested, "Let the patients exercise for a while to help recover, but you still have to be careful to prevent falls and injuries."

"Then let the nurses assist?" Hu Jia thought for a while and suggested, "The critically ill patients really can't move now, and their intubation wounds are a little swollen and oozing blood. Patients, we can still help them walk around."

"Can the nurses take care of it?" Xu Yourong is more worried about the work intensity of the nurses and sisters, "We still have a lot of patients now, and they are standing and walking one by one... This is still time-consuming. Is it too long?"

"It's just that our current staff may not be enough." This question made Hu Jia feel a little helpless, "But... I think maybe we can mobilize the patients in the North Sixth District?"

There are currently more than 20 patients in the North Sixth District under Qian Hongjun's management, most of whom have reached the point where they can be transferred to the shelter hospital for second-level medical care. The reason why they were not transferred to the shelter hospital immediately is mainly Or because the current number of shelter hospitals is still not enough.According to the notice from the higher authorities, the second batch of shelter hospitals will still mainly accept community patients with mild symptoms.The transfer of mildly ill patients from designated hospitals still needs to wait until the beds in the shelter hospitals are free.

Therefore, now the more than 20 patients who have basically recovered, but the PCR test is still positive, are resting in peace in the ward of the North Sixth District.They are not very old, and their physical condition is quite good.In this case, these patients are fully capable of being "mobilized".

"I'll ask Director Qian later." Sun Li'en was not sure if this proposal was feasible, after all, patients with mild symptoms are also patients.Although their lung shadows have improved significantly, they are not healthy people after all.Let these patients who have not fully recovered to take care of critically ill patients, help them stand up and do light activities... This is actually a bit unreasonable.

"I'll ask those volunteers." Bruen volunteered, "If it's just to keep people from falling, I think these volunteers can do the job."

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Half an hour later, Sun Lien received responses from Qian Hongjun and Brunn—the situation was much better than he expected.

Among the patients in the North Sixth District, five young people in relatively good health were willing to come to the North Fifth District to help.Among the volunteers in North Fifth District, eight people are willing to help take care of standing patients.These 13 people, together with the existing nurses, can fully undertake the task of caring for the standing activities of critically ill patients.

According to Qian Hongjun, the mildly ill patients in the sixth northern district are actually quite positive.However, considering that these positive patients may still shed the virus when they went down from North Sixth District to North Fifth District, he deliberately persuaded a group of enthusiastic patients who were prone to cough to go back.The volunteers, on the other hand, considered that the security work they usually carry out is of great significance, so they only chose eight people in the end.Anyway, Brunn said that the volunteers were arguing one by one in order to compete for the nursing job.

The way the volunteers ended up deciding who the caretaker jobs belonged to was very interesting—they had a lottery arm wrestling.After two rounds of round robin, eight volunteers with the strongest upper body strength were finally selected to participate in the task.

"Let the patients get used to standing for a short period of time first, and then move to the bedside for pacing and light activities." Regarding the activity intensity of the patients, Sun Lien made detailed arrangements after communicating with Director Huang Wenhui, "Our current goal is to One, let the patient move more while ensuring safety."

"It would be great if they could be made to be the same as the patients in the makeshift hospital." Xu Yourong said with emotion from the side, "I read the news yesterday that the nurses in the makeshift hospital are already leading the patients to dance in the square."

(End of this chapter)