I can see the status bar

Chapter 31 Gangrene
The heart and lung monitors equipped in the emergency room of the Fourth Central Hospital are a batch of brand-new equipment, and some extravagantly choose disposable electrode patches with negative pressure adsorption.The purpose is to prevent possible skin damage in adhesive electrode patches.

However, near the patch attached to Chen Wen's chest, black and red blood had already oozes out.If you look closely, you can even see adipose tissue exposed to the air, as well as curled and dead epidermal tissue.

"I'm going to get the debridement kit." Sun Lien was also a little flustered, he had never seen such a serious skin injury.The sores the size of coins, even if he only glanced through his clothes, made him feel a twinge in his heart.

Chen Wen fell into a drowsy sleep under the influence of the medicine, and Shen Qingmei's face turned pale with tension.She almost cried and asked, "What's wrong with her? What's going on here?"

"Calm down first." Liu Tangchun winked at several nurses, telling them to go out first with Shen Qingmei who was about to collapse.He frowned and lowered his head to carefully observe the bleeding sores.

"Director Liu..." Sun Lien ran over holding the debridement kit in small steps. Seeing Liu Tangchun looking down at the situation, he quickly put the debridement kit in his arms on the small cart beside him.He leaned over and asked in a low voice, "Is there something wrong?"

Liu Tangchun glanced at Sun Lien, "What do you think is wrong?" His tone was kind, as if he was about to test Sun Lien.

Sun Li'en looked at the status bar above Chen Wen's head. The hypercalcemia and hypercoagulation status were still there, but the rest remained unchanged.It doesn't look like the disease is progressing in any particular way.He looked down at the apparently necrotic sores again, wondering, "We've already given her dexamethasone. Glucocorticoids can suppress her immune system, so it shouldn't be because she's allergic to the electrode patches." The reaction, is it a side effect of the drug?"

"It should be." Liu Tangchun nodded, "Diseases that can cause multiple blood clots generally do not cause skin necrosis. Her symptoms before being sent to the hospital should not have such a situation. The most reasonable explanation is that we give Her medication, caused the necrosis."

Sun Li'en looked at Chen Wen on the hospital bed, and sighed, "I'll stop warfarin for her right now... But she has just undergone coronary intervention, so she can't use dipyridamole."

"You are her attending doctor." Liu Tangchun smiled, "So, what should we do now?"

Sun Lien was silent for a while, quickly searching for other anticoagulant treatment options in his mind.The side effects of warfarin on Chen Wen were too serious. If the large area of ​​necrosis cannot be controlled immediately, the dead tissue may enter the circulatory system along the capillaries, which may cause sepsis.However, if only heparin is used for anticoagulation, large doses of heparin will inhibit Chen Wen's bone marrow function.Together with dexamethasone, the suppressed immune system will not be able to deal with the gangrene that has developed.If the condition continues to deepen, once the gangrene that appeared above Chen Wen's chest extends downward and breaks through the abdominal wall, it is likely to cause necrotizing fasciitis.

Now, it's a dilemma.If the anticoagulant treatment is stopped, the thrombus will continue to grow, and enter the lungs to cause pulmonary embolism or enter the brain to cause stroke, which may directly kill Chen Wen.Continuing the anticoagulant treatment with heparin may cause the gangrene to continue to expand downward, form necrotizing fasciitis, and lead to sepsis.With severe infection, Chen Wen will still die.

"Use Rivaroxaban for her." Sun Li'en raised his head with firm eyes. "Stop warfarin, maintain heparin, and see if the side effects of warfarin can be alleviated. Increase the dose of dexamethasone from 10 mg to 20 mg. Inject levofloxacin and ciprofloxacin, Strict debridement of the wound, and then external application of compound polymyxin."

"A very firm anti-infection method." Liu Tangchun nodded. "that's all?"

Sun Li'en was silent for a while, "Strengthen nursing care and monitor the development of gangrene at any time. Once there is a sign of breaking through the abdominal wall... it will be resected."

"Where is the resection?" Liu Tangchun asked, "How big is the resection?"

Under Director Liu's continuous questioning, Sun Li'en couldn't handle it anymore.His silence was longer and longer each time, and his frown became deeper and deeper.

"You know the treatment plan." Director Liu said suddenly, "With such a firm anti-infection plan, even ciprofloxacin, which is extremely risky for minors, is used. But you should be very clear What is the safest solution."

Sun Li'en shook his head, almost pleading, "She is only ten years old, the consequences of surgical removal of breast tissue are too painful for her."

"Pain means she's still alive." Liu Tangchun's voice also lowered, "Pain is evidence of life. If she dies of necrotizing fasciitis, what's the use of the preserved breast tissue? Lien, what do you want?" Remember..." Liu Tangchun stared straight at the young man whom he admired so much, "Our job is to save lives and heal the wounded. Rescuing patients who are about to die and bringing them back from hell is our primary goal."

"At least... observe again." Sun Lien looked at Chen Wen who was lying on the bed.Her face seemed contorted from the constant pain in her sleep. "Heparin may alleviate side effects of warfarin..."

"She can wait until the gangrene penetrates deep into the abdominal wall." Liu Tangchun sighed. "Go and inform the family first."

"You... want to cut it off..." Shen Qingmei opened her mouth wide, "No, no! I will never agree!"

"As a doctor, I don't want to do this even more than you do." Sun Lien understood the reaction of the young mother in front of him very well.He whispered, "Warfarin's side effects are very rare, but it did appear in Chen Wen's body. If the gangrene is not removed before it breaks through the abdominal cavity, her life will be in danger."

Shen Qingmei covered her face in silence for a while, then suddenly asked, "Can you transfer to another hospital?"

"Her condition is not stable, and a hasty transfer may cause her thrombus to continue to move. If she is transferred by helicopter and she suffers from a pulmonary embolism on the plane, there is no way to deal with it." Sun Lien also considered this issue, but the reality The circumstances simply did not allow for a transfer. "If you use an ambulance to transfer, it will take at least 10 hours. During this time...her gangrene is likely to convert to necrotizing fasciitis."

"Before you...have to remove her breast tissue, how much time do I have?" Shen Qingmei wiped away the tears on her face, "Can I invite experts from the capital and Shanghai stock market to diagnose her?"

"Based on a conservative estimate, I think there may be about two hours." Sun Lien shook his head regretfully. "Time...may not be enough."

"I always want to do something for my daughter." Shen Qingmei took out the phone and walked out of the rescue hall, "Mr. Wang, I want to ask you for a favor."

The figure of this woman appeared extremely tall in Sun Lien's eyes.

Ask for a recommendation ticket!

　I came back too late yesterday, and the worst thing is, the network was disconnected halfway through the update... WPS can't even save.It can only be copied locally, and then not sent until now.

　　
　
(End of this chapter)