I can see the status bar

Chapter 1082 Emergency Consultation

Square dance, which has its own attributes of "aunt" and is naturally "optimistic", has suddenly become the focus of attention of the people across the country.

There is an old Chinese saying that goes, "Singing and dancing raises peace".It usually refers to everyone singing and dancing to celebrate peace.It is mainly an idiom used to describe the peaceful and prosperous times, and the people live and work in peace and contentment.But sometimes, it also refers to whitewashing the peace and paralyzing oneself with singing and dancing.

Sun Lien's worry is similar to the deep meaning of this old saying.He has been somewhat concerned that encouraging critically ill patients to stand and move slightly might show some short-term benefit.But in the long run, whether such changes will lead to more serious problems for patients is anyone's guess.

The human body is really too complex a precision instrument, even if it is other industry experts, they cannot assert that this measure will definitely be better, or it will definitely be worse.Doctors can only take one step at a time and use the strictest monitoring methods to ensure the safety of patients or allow them to receive treatment as soon as possible when problems arise.

Therefore, during the first "medical standing" process that started half an hour later, there were more than a dozen doctors standing outside the ward.There are two ambulance vehicles, one is equipped with various rescue drugs, and the other is directly equipped with a defibrillator.

The patient in the room saw the doctors outside the door through the door, and he suddenly became a little nervous, "You... what are you doing?"

"It's okay, it's okay, just pretend we're not here." The doctors quickly comforted them, and then shrank back to the place where it was difficult to observe at the door.In the room, Yuan Ping'an put his hands behind his back and waved vigorously, signaling his colleagues to move away quickly.

The patient who was half sitting on the bed looked suspiciously, and then muttered, "I forgot how to stand up."

"You move slowly, sit on the side of the bed for a while before getting up." Yuan Pingan took the opportunity to emphasize again the essentials of getting up to prevent falls.According to the routine, the patient should lie down for 1 minute after waking up, then sit up and sit on the edge of the bed for 1 minute, and then stand up slowly and stand for 1 minute.After three 1 minutes, start the activity again.This set of actions is mainly to prevent hypotension caused by sudden changes in the patient's body position.However, the "volunteer" who agreed to participate in the experiment had been awake for a long time, which saved the first minute.

Under the breathless attention of the doctors inside and outside the room, the patient stood up slowly while supporting the walker.

Like a child learning to walk again, he wobbled, but stood up happily.

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Sun Lien did not follow the patient's standing and moving with other colleagues.He was called out of the red zone by a sudden phone call—it has been so long since he came to Yunhe, this is the first time that Sun Lien left the red zone when the N95 mask did not enter the "must be replaced time", and then returned to the red zone after taking a bath and disinfection green zone.

The call to call Sun Lien came from Liu Pingchuan.And he is not in He'an Hospital now.

He, Chen Tianyang and Song Wen are in the high-tech campus of Tongde Affiliated Hospital.

"What's the situation?" Sun Lien rushed to the green zone and asked Zhong Yu, the head nurse on duty, "Why is Dean Liu looking for me in such a hurry?"

Dean Liu’s phone call was conveyed by Zhong Yu. According to the head nurse Zhong’s feedback, Liu Pingchuan’s voice on the phone sounded very anxious, and the content was very simple, “Let Sun Lien come to the high-tech branch of Tongde Hospital immediately, The car to pick him up is already on its way."

"I don't know either." Head nurse Zhong shook her head very honestly, then handed over Sun Lien's cell phone, "Why don't you call Dean Liu directly, Director Sun?"

Sun Li'en nodded, no matter what Liu Pingchuan was in such a hurry, it would take twenty to ten minutes at the fastest from the Yunhe City Infectious Disease Hospital to the high-tech zone.Take advantage of this time to ask to see what happened, so that he can also be mentally prepared.

"The car has arrived?" Liu Pingchuan said quickly after answering the phone, "You tell the driver to drive faster and come to the High-tech Zone Hospital as soon as possible."

"I just came out of the red zone, and I'm walking downstairs." Sun Lien ran out with the phone tucked between his shoulders and a jacket in his hand. After running two steps, he was grabbed by head nurse Zhong, and then Sun Lien There is another ordinary medical surgical mask in his arms.

"Put on the mask." Zhong Yu reminded, and then pushed Sun Li'en on the back, "Be careful on the road."

Sun Li'en, who was on the phone, couldn't say thank you to the head nurse. He quickened his pace and put on a mask for himself in a very awkward posture.

"...So, what's the matter?" Sun Lien asked on the phone, "Do you need me to bring something there?"

"You don't need to bring anything. You are here for a consultation." Liu Pingchuan calmed down a little and said, "I have a patient. I discussed it with Dean Song and decided to let you come for a consultation."

"Is it the new crown? Is it very sick?" Sun Lien asked with a frown. He didn't think that his "talent" for diagnosis could help a patient whose diagnosis had been confirmed.

"It's a confirmed diagnosis, but it's not just a serious problem..." Liu Pingchuan sighed, "This patient is...the dean of He'an Hospital."

He'an Hospital was notified on January 1 that it was designated as a designated hospital, and the old hospital area had to complete the renovation in the shortest possible time and begin to admit patients.From 21:21 p.m. on the [-]st, Liu Lianzhi never left He'an Hospital.

As the dean, Dean Liu Lianzhi, who was born in neurosurgery, led all the medical staff and logistics support personnel of the whole hospital to fight hard. After three consecutive days of high-intensity work without sleep, He'an Hospital finally completed the ward before the stipulated time limit. remodel.After completing the renovation of the ward with his colleagues, this middle-aged man who had just recovered from a cold on the 51th, not long after his 20st birthday, took the doctors first to discuss the whole situation of the patients diagnosed with the new coronavirus. Ward rounds and inspections were carried out in the ward for treatment.

This is a dean who, like Song Wen, is used to standing on the front line and leading his colleagues to work hard.

However, just after the first ward round, on January 1, Dean Liu suddenly developed chest tightness, cough, fever and shortness of breath.The pulse oxygen saturation dropped to 25%, and the blood oxygen saturation was still lower than 88% under high-flow oxygen support.

Because he is a doctor and the director of the first hospital of a designated hospital, Liu Lianzhi quickly got the opportunity for PCR testing.But this test made almost everyone's heart tremble.

The nucleic acid test result was positive.

With a positive nucleic acid test result, and the resting finger pulse oxygen saturation is less than 93%.Dean Liu Lianzhi has been classified as a critically ill patient since the onset of symptoms.

He was admitted to the isolation ward that he and his colleagues urgently remodeled, and even though he was suffering from fatigue, Dean Liu was still working hard to maintain his working condition.As soon as he knew that he was diagnosed, he immediately called all his colleagues one by one.He also asked the nosocomial infection office of the hospital to intervene and conduct nucleic acid tests on all colleagues who had close contact with him.Fortunately, the nucleic acid test results of the others were all negative.

In the ward, Dean Liu's condition began to be the same as that of other confirmed severe patients.But unlike other patients, his condition deteriorated very suddenly.

On February 2, after more than ten days of treatment, Liu Lianzhi's condition improved greatly.He was already able to sit by the bed to handle official business, and even carried a thermos bottle to fetch water from the water room by himself.No matter how you look at it, President Liu Lianzhi's condition is improving rapidly. Although the shadow area of ​​the lungs is still not small, at least the symptoms are much lighter.

At that time, Liu Lianzhi himself felt that he was almost recovered.He even rejected his wife's request to accompany him—his wife is working as the head nurse in the ICU of the High-Tech Campus of Tongde Affiliated Hospital in Yunhe City.During this time, the only request he made to his wife was to ask her to bring some change of clothes to He'an Hospital on January 1.If He'an Hospital is designated as a designated hospital, he may not be able to go home.

However, on February 2, that is, at noon yesterday, Liu Lianzhi's condition suddenly deteriorated.His inflammatory indicators are soaring rapidly, the interleukin-9 level has reached 6pg/ml, and the C-reactive protein is 194mg/L.At the same time, his blood oxygen saturation began to drop rapidly. With the support of six liters of pure nasal oxygen per minute, Liu Lianzhi's finger pulse oxygen level was only 165%.

Liu Pingchuan from the Department of Intensive Care Medicine of He'an Hospital immediately treated Liu Lianzhi accordingly. The hormone has been given to 4 mg per kilogram of body weight, but the inflammatory indicators still cannot be lowered - he also developed symptoms of arrhythmia and hyperkalemia.

Liu Lianzhi has a big problem. In Liu Pingchuan's opinion, if he wants to save Liu Lianzhi's life, he must be given ECMO life support and triple therapy including tocilizumab should be used to curb the inflammatory storm.

But... He'an Hospital does not have ECMO.Moreover, Liu Lianzhi himself was not very cooperative with the treatment.I don't know whether it is the change in cognitive status caused by hypoxia, or the "self-judgment" as a doctor. He has been reluctant to accept the ventilator, but asked to use more bronchodilators and cough and expectorant drugs.

Seeing that the situation was not quite right, Liu Pingchuan decisively used diazepam to calm Liu Lianzhi, and then forcibly put him on a positive pressure ventilator.Anyway, after raising his finger pulse oxygen saturation to 91%, Liu Pingchuan immediately contacted the Yunhe Health Commission for help.

A front-line doctor and the director of a designated hospital were infected... This is a big deal.Although the staff of the Health and Medical Commission were exhausted to the point of numbness, they could still realize how important it is to cure Liu Lianzhi.

If Lao Liu is carried over safely, it will be an encouragement to all medical staff.If Lao Liu had a mistake... How uncomfortable would the staff who have been working hard on the front line feel?
That is a doctor, the director of a hospital, the backbone of hundreds of thousands of people, and comrades-in-arms marching forward together against the gunfire.If we can't even snatch our comrades back, then what are we people doing all the way here for food?
That's what Liu Pingchuan thought.He is not a person who is easily swayed by his emotions, but this time, Liu Pingchuan felt that the superficial temporal artery on his head, including the parietal branch and the frontal branch, were throbbing.No matter what, Lao Liu must be snatched back.

With the help and coordination of the staff of Yunhe City Health Commission, Liu Pingchuan personally led the team and sent this neurosurgery colleague like himself to the High-tech Campus of Tongde Affiliated Hospital.Afterwards, he directly called and summoned all the members of Yunhe in the expert joint meeting of the Song'an Provincial Medical Team.

It is the national team of the national team that has taken over the high-tech zone of Tongde Hospital.Nurses from four top hospitals in the capital, including Tongxie Hospital, and the Henan Medical Team presided over the admission and treatment of patients here.At the same time, this hospital area has also become the hospital with the highest medical level and medical strength in the entire Yunhe.

When the car that picked up Sun Lien stopped at the gate of the high-tech campus, Sun Lien felt his legs go weak after a long absence.He took a deep breath through the mask, and then strode into the gate of the hospital - the next battle will not be easy, and he only hopes that with his best efforts, he can fight for that Yuanyuan Liu who has never met before. Long snatched back a glimmer of life.

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When Sun Lien arrived at the conference room on the fourth floor, the atmosphere in the conference room was very solemn.

"His current problem is not just an inflammatory storm." The bald head who knocked on the table to emphasize the problem looked familiar, and Sun Lien squinted his eyes to identify it for a few seconds before he realized that this person was indeed an acquaintance—this was Zhu Minhua, the chief director of the emergency department of the Tongxie .

Professor Zhu knocked on the table and said, "The top priority now is to stabilize his circulatory system. Only when the circulation is stabilized can we start the next treatment. If you can't stabilize the circulation, turn around and get immunization, immunization What are you doing? No matter how serious the immunity problem is, it won’t kill anyone in one day!”

"Liu Lianzhi is 51 years old. If he has immune problems in his current situation, the risk of cardiovascular and cerebrovascular diseases will be very high." Liu Pingchuan and his former junior brother fought tit for tat. It's also stabilizing the cycle!"

Sun Lien quietly walked to Chen Tianyang and sat down. He looked at the inspection index data projected on the wall by the projector, as well as the monitoring instrument data on the LCD TV in the meeting room and asked, "What's the situation now?"

"Preparing for ECMO, Zhu Minhua and Liu Pingchuan are arguing." Chen Tianyang said succinctly, "Lao Liu asked for plasma exchange immediately to cut off the ongoing inflammatory storm. But Zhu Minhua thinks this operation is too risky. Once a dialysis reaction occurs, Liu Lianzhi's blood pressure may not be able to control it."

"Tocilizumab is not effective?" Sun Lien asked with a frown. Just looking at the interleukin-6 level of the inspection index, it is hard to believe that Liu Lianzhi has already used tocilizumab-this drug is a very effective interleukin-6 Logically speaking, after using the receptor monoclonal antibody even just once, Liu Lianzhi's inflammation index should not be so high.

"It was discussed just now, and the current consensus is that Lao Liu's reaction to tocilizumab was not very good, probably because the main mediator of his inflammatory storm was not interleukin-6." Chen Tianyang shook his head, "But hormones The effect is not good, I have used 240 mg..."

"That is to say, the currently verified substance that mediates the inflammatory storm is not sensitive to glucocorticoids, and has no effect on tocilizumab..." Sun Lien frowned and asked after thinking, "Is it interleukin-2?"

"The examination is being supplemented and clarified, but we all feel that it should be." Chen Tianyang nodded and said, "That's why Lao Liu asked for plasma exchange as soon as possible." He sighed and said, "I just suggested to try some Xenipr , but none of them agreed."

Zenipa is a monoclonal antibody against the interleukin-2 receptor, and its effect is actually similar to that of tocilizumab.It is usually clinically used for immunosuppression after liver transplantation.The reason why Chen Tianyang's suggestion was rejected is also very good - the use of Xenipex at the time when 240 mg of glucocorticoids has been used will greatly increase the risk of rapid virus proliferation.Now glucocorticoids are not effective because the level of interleukin-2 is too high.However, if the concentration and action of interleukin-2 is inhibited with Xenipex, the effect of glucocorticoids may increase exponentially.Such consequences are unbearable for the current Liu Lianzhi.

(End of this chapter)