I can see the status bar

Chapter 1010 D+2 day (2)

The rescue was carried out in a busy and orderly manner. The rescue team mainly divided the treatment of Uncle Peng into three groups—Yuan Ping'an's side was mainly responsible for the treatment and rescue of the circulatory system, while the other two groups were responsible for correcting the internal environment of Uncle Peng and carrying out other procedures. Vital signs detection.

The internal environment is mainly aimed at hyperkalemia and respiratory acidosis.The treatment plan adopts the fastest mixed infusion of calcium and glucose insulin, while respiratory acidosis is treated with 5% sodium bicarbonate solution.

As for other vital signs, Zhou Ce and others immediately brought in a dialysis machine after confirming that Uncle Peng had hyperkalemia.However, because Yuan Ping'an and his group are taking turns performing chest compressions on Uncle Peng, there is no condition for intubation yet.So I can only wait on the sidelines for the time being, and start the follow-up treatment after the situation stabilizes.

If the situation is stable and does not come back...then this thing is useless.

Sun Li'en and the others stared nervously at the various indicators on the screen outside. The red warning value kept flashing, and the various numbers flashed rapidly, making the viewers even a little dazzled.

But...it's not good, very bad.

The rescue of Uncle Peng has been carried out for 10 minutes, and Yuan Ping'an has changed five people to perform chest compressions in turn.The epinephrine has also used 5ml.But as soon as they stopped the chest compressions, Uncle Peng's heartbeat would start to slow down rapidly and even tend to stop.It can be said that as long as they stop, this person will be finished immediately.

Sun Lien frowned. If he couldn't see the patient, he couldn't see the status bar.Without the status bar, it would be difficult for him to determine what the cause of the patient's current cardiac arrest is—hyperkalemia, myocardial necrosis caused by long-term hypoxia, metabolic acidosis, or multiple organ failure.

We can only rely on experience and the treatment response of the on-site doctors to see the situation.Sun Li'en leaned back, and began to frown and wonder if he might have missed something.

Time passed, and when the rescue lasted for 10 minutes, the doctors present were already ready to give up—ordinary patients still couldn't recover their heart rate after 20 minutes of rescue, and the probability of recovery was very low.Uncle Peng's lungs are infected by the new coronavirus, and it is even more difficult for patients with a course of more than ten days to be snatched back under such circumstances.

Two, 10 minutes, 25 minutes... The rescue is still going on, and the cumulative amount of adrenaline used has reached 15ml.But the treatment still hasn't had the results doctors wanted.

This kind of rescue is not the same as the rescue of patients with ventricular fibrillation. The electric shock of defibrillation is similar to giving a whip to the buttocks of a jumping horse to make it obedient and return to normal beating.But for a patient in cardiac arrest... whipping is of no use.The horse that was lying on the ground had to stand up again and regain its ability to move.

"It's useless to go on like this, look for a pacemaker." After 28 minutes of rescue, Sun Lien made a decision, "Use NTCP!"

No matter how Uncle Peng's cardiac arrest came about, and what causes the continuous bradycardia, these other factors are not very important when the drug stimulation is ineffective—at least not at present.

"Could it be myxedema coma?" In the intercom, Dr. Ma Yongfang put forward his own opinion, "The patient has hypothyroidism, and the heart rate will drop in an emergency state. At the same time, myxedema coma will also lead to respiratory failure of the patient. .Infections and sedatives can also induce myxedema coma..."

"His sodium is not high." Sun Lien frowned and thought for a while, but in this situation... there seems to be no other way, he pressed the intercom and said, "Give him a try of levothyroxine."

The current situation is to use a dead horse as a live horse doctor.Doctors have been taking medicines to control Uncle Peng's hypothyroidism. In theory, it is not easy for this kind of problem, also known as hypothyroid crisis, to occur.However, the simultaneous presence of the three main causes of hypothyroid crisis, infection, stress, and sedation, will indeed increase the probability of this situation. At least the possibility of myxedema coma is not zero.

The rescue is still in progress. For the four major treatment methods for hypothyroid crisis, only two of them can be used in the North Five District at present.Uncle Peng has been on incision and intubation, and the ventilator has reached the point where it can no longer be adjusted.The 100 mg levothyroxine given to the patient by Dr. Ma Yongfang has also been infused.The application of glucocorticoids has been put on hold for the time being—Uncle Peng’s daily dose of corticosteroids is about 140mg, and for the treatment of hypothyroid crisis, in principle, the daily dose should not exceed 300mg.It is not necessary to continue to increase the dosage now.

As for the maintenance of electrolyte balance... the dosage of 5% sodium bicarbonate has been given to more than 120mmol, and Uncle Peng's arterial pH has risen to 7.27, but the condition of cardiac arrest has not improved, and his condition is still very critical.

The rescue lasted for 10 minutes, and all the doctors who had fallen asleep gathered in front of the monitor at the nurse station in the yellow area.Discussions have been going on, but the rescue has never been effective—Yuan Pingan continued to perform percutaneous external cardiac pacing on Uncle Peng for 20 minutes, but his heart never returned to normal beating.

"It's ok." The rescue team carried out a 50-minute full rescue of the patient. As the director in charge, Sun Li'en finally gave the order to abandon the rescue. "Let's stop here and record the time of death."

"Patient Peng Weifa, male, 66 years old. Time of death... 1:26 a.m. on January 45." Yuan Ping'an's voice sounded exhausted, panting...very depressed.

Sun Li'en sighed and said, "Everyone has worked hard, you have done a good job."

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The failure of Peng Weifa's rescue made Sun Lien feel very bad.The aunt who cried "Farewell to my husband" into her mobile phone a few hours ago is like a nightmare, always lingering in Sun Lien's mind.It has been two days since he brought the team to Yunhe Infectious Hospital.None of the patients' symptoms improved, and three patients were even sent away.It can also be said that the two patients who were sent away on the day they first arrived were not familiar with the situation because they had just taken over the ward.But...from the day Sun Lien took over the North Fifth District, Uncle Peng was one of the patients that all the doctors paid close attention to and could even be said to be "focused on".After deciding to establish a temporary ICU, Uncle Peng was also transferred in.

But even so, Sun Lien and the others still had no way to prevent the patient from falling into the abyss of death.They have exhausted all means except ECMO.

Even with the help of the status bar, even with the joint assistance of many experts, even with the doctors of the rescue team who were on the verge of exhaustion for five to 10 minutes of treatment...but it was still useless.

Uncle Peng died in the early morning of the No.16 day after the onset of the disease, on the second day of the Lunar New Year.His life was forever frozen in this cold morning by the novel coronavirus.

He was hit hard, but Sun Li'en couldn't show it.He is now the chief director of a department, the leader of a medical team, and the highest-ranking doctor in charge of treating 47 patients.It is the backbone, reassurance, and pillar of hundreds of medical staff who rushed from Song'an Province to Yunhe to support them and fight the epidemic head-on.

Everyone can be depressed and lost, but Sun Lien can't.He also has to cheer for other colleagues so that they can bounce back and treat the remaining patients.

"Get ready to leave the cabin after finishing the paperwork." Sun Li'en looked at the time and said on the intercom, "I couldn't work with everyone inside today, you have worked hard."

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After handing over to the team led by Director Lu Zhimin, Sun Lien and other team members returned to the hotel.Just worked all night, everyone is tired and hungry.But not many people decided to go to the cafeteria to eat, and more doctors chose to go back to the house to take a shower and sleep. The restaurant guarantees that hot dishes and soup are available 24 hours a day, which is convenient for the doctors who just got off the night shift.

Together with Hu Jia, Sun Lien went to the restaurant to choose some food.The two of them sat behind a table, and after a hasty deal, Hu Jia had to bid farewell to Sun Li'en temporarily—according to the current epidemic prevention regulations, all members of the medical team must eat alone and live alone.Even couples must sleep in double beds in two different rooms.

Such an arrangement is of course somewhat unreasonable, but all medical staff can understand the meaning of this arrangement.This rule is to protect doctors, but also to protect everyone.

Of course, Sun Li'en didn't want to be cuddly and intimate with his girlfriend either.Now he has neither the mood nor the strength.If the situation permits, what he wants to do most now is to sleep with Hu Jia in his arms.I am used to having someone by my side, now I come to Yunhe and sleep in a double bed by myself every day, and I always feel empty in my heart when I wake up in the morning.

After returning to his room, Sun Li'en sat on the bed for a while, then turned over and sat up.He took out a notebook from his bag, and began to write records.

"Before the patient died, the peripheral blood lymphocyte content was low, and the absolute value of helper T cells was low, suggesting that the patient's immune system may be suppressed..."

Medicine is a science of hope based on the sorrow of countless individuals.Human death is unavoidable in the end, but... Sun Lien hoped that at least the patient's death would become more valuable.

However, it is difficult to make any valuable judgment on such a new type of disease based on Sun Lien alone.For this reason, Sun Lien asked Director Lu to help scan and send a copy of all the inspection reports sent by Peng Wei.Then he sent screenshots of the content he thought needed attention to Dr. Pascal who was still guarding the rear in Ningyuan.

"I suspect that the patient's lymphocytes are reduced because of the massive use of hormones." Sun Lien asked Dr. Pascal in WeChat, "Due to the reduction of lymphocytes and macrophages, the phagocytosis of the lungs is reduced, resulting in a large number of infections, and Cells and cellular debris killed by Tc cells cannot be cleared - so the lungs deteriorate rapidly."

"It's possible, but there's no evidence." Dr. Pascal quickly replied, and then asked, "You still want to do scientific research by the way?"

"Scientific research is the means and method to guide clinical work." Sun Li'en replied, "but I can't take care of it now. I sent you a message because I want to consult this question-when the human body's phagocytosis and clearance function is weakened, I want to stop it. The immune system is overreacting, causing irreversible organ damage ... Is there any other way than to use corticosteroids?"

"Then we can only start with inflammatory markers." Dr. Pascal replied after about ten minutes, "You need a drug that can precisely inhibit or reduce Tc (cytotoxic T lymphocyte) cell proliferation, A drug that does not have too much effect on Th (helper T cell) cells."

"Yes." Sun Lien asked, "Do you have any suggestions?"

"This is considered an over-the-range medication, and there is currently no evidence and basis for such usage—not even a supporting conjecture." Dr. Pascale advised, "I suggest you wait, at least there must be relevant evidence to prove that patients The phagocytosis and clearance function in the lungs is weakened..."

Sun Lien didn't finish listening to this voice, "Old Pa, the patients in my hand don't have so much time to wait for the evidence, we will find a way to find it ourselves, please tell me first, is there such a method?"

"There are means." Pascal sighed, "After there is sufficient evidence to prove that irreversible organ damage is closely related to phagocytic clearance function, you may consider giving the patient some tocilizumab."

(End of this chapter)