I can see the status bar

Chapter 1015 D+2 day (7)

Turning over a critically ill patient is a job that sounds simple but is very complicated in practice.

Ordinary people just need to use some effort to turn over.But it is much more difficult to turn over the critically ill patients.Almost every one of these critically ill patients is connected with a bunch of monitoring lines and support lines. During the turning over process, the vital signs of the patient must be kept stable, and at the same time, the smoothness and safety of these complex lines must be maintained... This job is really not ordinary. trouble.

Sun Li'en felt like he and the other doctors were playing some super-large and complicated game like turning rope.Operational complexity is exponentially related to device size.

It took half an hour to turn the first patient over. Sun Lien and the others took a few steps away carefully, and then began to observe the patient's vital signs—it seemed that a slight movement would affect the patient's vital signs like.

"Okay, this one is stable." After observing for a few minutes, Sun Lien nodded, but there was no new prompt on the status bar, indicating that the problem should not be serious. "Let's go, let's go to the next one."

Thanks to the presence of Xiao Guo and Hu Jia, with the help of the strongest nurse in the entire department, the process of turning over was relatively convenient.

After a busy afternoon, a group of people were busy until eight o'clock in the evening.After turning over twenty patients, Sun Li'en stopped everyone.

"Okay, that's all for today." Sun Li'en nodded in satisfaction and said.

Those who are turned over are critically ill patients who have not yet had a tracheotomy. Critically ill patients who have had a tracheotomy are relatively contraindicated for prone position ventilation. Sun Lien does not dare to turn them over for the time being.Maybe you can consult the doctors of respiratory medicine or intensive care medicine later to make a decision.

And after turning over, people can't let people lie on their stomachs like this.According to relevant experience and expert consensus, this treatment plan needs to be maintained for a relatively long time-the daily prone treatment time needs to be 16 hours to 20 hours.

After turning over, more attention should be paid to the patient's finger pulse oxygen level.Discontinuation of prone ventilation should be considered if the patient's finger pulse oxygen status has not improved after four hours of prone ventilation.

Prone position ventilation can improve the ventilation of the patient, increase the oxygenation level, and reduce the dead space ventilation.And this change is highly time-dependent—most patients show improvement within an hour or so of turning prone.In a small number of patients, it takes close to four hours before the blood oxygen level increases.Therefore, four hours is a critical observation period.Patients who have improved during this time period can continue to maintain their status.If there is no improvement after four hours, consider returning them to their normal position.

The prone position is not conducive to the rescue of patients, and may delay the implementation of rescue measures including cardiopulmonary resuscitation.This kind of thing can actually be understood after a little thought-the patient is lying on the bed with his chest facing down. If he wants to perform chest compressions or shock defibrillation in this state, he must first turn the person over, right?
With the assistance of Hu Jia and Xiao Guo, it took a group of doctors more than ten minutes to turn the patient back safely.If there is an emergency, a delay of more than ten minutes may directly cost a life.

If the patient can achieve improved blood oxygen saturation in the prone position, the benefits of doing so still outweigh the risks.If the ventilation in the prone position cannot achieve the needed improvement, there is no need to keep them in the prone position, and it is better to turn them back in advance to consider whether to intubate in advance.

In addition to doing everything possible to improve the blood oxygen and circulatory system of patients, the current main strategies of the treatment group are two-fine management and moving the barrier forward.

The regimen used is different for every patient.Individually differentiated treatment programs are a principle rather than a direction of effort in the North Fifth District.The in-out volume of each patient has been finely managed, and the B-ultrasound assessment is performed every hour on average.

On the other hand, moving the barrier forward has also become an important treatment option.Generally speaking, if the patient's respiratory rate is greater than 35 times per minute, and the blood oxygen saturation is lower than 95% and cannot be improved by oxygen inhalation, doctors need to consider using a positive pressure ventilator to maintain the patient's assisted breathing.In the North Fifth District, this data was corrected to a respiratory rate greater than 30 times per minute and a blood oxygen saturation lower than 96% after oxygen inhalation.

Starting positive pressure breathing earlier means that hypoxemia can appear later.The emergence of hypoxemia often means that the patient's circulatory system has entered a decompensated period-damages will gradually begin to accumulate, and the patient's body organs will begin to suffer from hypoxia little by little.When other organs can't tolerate the damage and completely lose the ability to continue working, the systemic organ failure caused by respiratory distress syndrome will break out.

The logic of treatment in advance of the threshold is here-the earlier the patient is given breathing assistance, the easier it is to reduce the hypoxic damage to the patient's systemic organs.

The pneumonia caused by the new coronavirus infection... In essence, it should be a self-limiting disease, at least with a self-limiting tendency.

So far, all antiviral treatment options have not been proven effective.It may have some effect, but it is definitely not to the point of "can be promoted as a standard therapy".

As a newly discovered disease, it is difficult to find any medicines that are naturally effective for it.Maybe tomorrow, many researchers will be able to find the most effective treatment plan, but maybe... the special medicine will never appear.

Before effective drugs are discovered, there is essentially only one thing doctors can do—try their best to lighten the burden on patients' body organs and help them survive.

No one can know when a patient can build up an immune response to the virus.No one knows when the human body will produce enough antibodies to neutralize the virus in the patient's body.

Aunt Peng and Bed 14 seem to have some hope of neutralizing the virus, while Mr. Shen, who is on ECMO... the situation is still unclear.

Enhance the immune system of the patient, maintain the vital signs, and then all that needs to be done is to procrastinate.Help them procrastinate until the virus is neutralized by antibodies and the lung damage begins to be repaired.If you drag to the end, you will win.

·
·
·
Two of the patients who were ventilated in the prone position still had no oxygen improvement after four hours.After discussion, Sun Li'en and others turned them back again.And the lower tube was cut in the patient's throat, and mechanical ventilation was started.

These two patients were very conscious, and Sun Lien could clearly feel that they were very nervous when they were being mechanically ventilated.

"You are too tired now." Sun Li'en comforted, "Using this will allow you to take a good rest and sleep, and when you wake up, your illness will be cured."

"I... dare not sleep." A 55-year-old middle-aged woman was about to be intubated.She held Sun Li'en's wrist tightly, and said intermittently and pleadingly, "I'm afraid that once I sleep... I won't be able to wake up."

"Auntie, you really need to take a good rest." Sun Lien stared at the middle-aged woman's status bar, which proved that she had "lack of sleep" for more than 80 hours. She hadn't closed her eyes for more than three days. "Sleep, sleep well, so that your body will have the strength to fight against the virus."

"I can't sleep..." the aunt shook her head gently, "my daughter is about to give birth, my old man has a fever, and my son-in-law is busy on the street all day long and can't come home... I dare not sleep, I fell asleep Who will miss them?"

The words are endless, and it can be seen that the aunt is already a little confused under the condition of hypoxemia and lack of sleep.

"Auntie, they are all thinking about you now." Sun Lien patted Auntie lightly and squeezed his hand, "Intubate you now so that you can recover quickly. People are still waiting for you to hold your grandson, waiting for you Give them something delicious."

These two words seemed to poke into the aunt's heart like magic. Her eyes blurred for a moment, then she nodded and said, "Yes, I still want to hug my grandchildren and cook confinement meals for my daughter..."

"So let's get well soon and get a good night's sleep." Sun Lien felt that his nose was a little sore. The person in front of him was no longer a patient who was afraid to go to sleep because he was worried about his serious illness. The person lying in front of him was a A mother—a mother who is seriously ill herself, but still misses her daughter's family. "When you wake up, you will be almost cured, and you can prepare to be discharged from the hospital."

"Yes, yes, get well soon." Auntie's eyes lost focus again, and this time the focus lasted for several seconds. "Then... when can I pull out this tube? Can it take a week?"

"We'll try our best." Sun Li'en spoke in a nasal voice, and he felt his lips trembling.After taking two deep breaths and trying to calm down, Sun Li'en tried to smile and said, "So Auntie, the sooner you cooperate with us, the sooner the tube can be removed and discharged in a healthy manner."

"When I get out of the hospital, I'm going to go back and make a big pot of lotus root pork ribs soup. I made it delicious." The aunt gradually let go of Sun Li'en's wrist, and she said to the young doctor in front of her, "Young man, save me!" Help me, Auntie has gone out and brought you soup."

"Don't worry." Sun Li'en held back the tears in his eyes, and patted the aunt's hand again, "I must go out and drink the soup you cooked, and I will chase you all the way to your house when the time comes, and I will drink this soup too superior!"

The other colleagues saw that Sun Lien's mood was a little unstable, so they hurried over to help and asked Sun Lien to go outside for a while.Hu Jia glanced at Sun Li'en worriedly, then took his place and continued to soothe the patient's emotions.

Sun Li'en took two steps back, his goggles were covered in fog, and he could hardly see the road clearly.Walking out of the room, he put his head against the cold window, trying to calm his head a little.

"Go and call her family." Hu Jia walked out of the ward, and whispered to Sun Lien, "Are you okay?"

"The mood was a little fluctuating just now." Sun Lien cleared his throat, then winked at Hu Jia, "Call the patient's family to inform them about the gas crisis, right?"

"Yes." Hu Jia looked at Sun Lien and asked, "Are you sure it's all right?"

"What else can I have a problem with if I make a call." Sun Lien patted his stomach - no way, you can't touch the chest and above in the red zone. "Okay, I'm going to call now."

It was my aunt's daughter who answered the phone.This made Sun Li'en a little nervous - on the registration information, this phone number is my aunt's wife.

"How is my mother?" After learning that the caller was a doctor from Yunhe City Infectious Disease Hospital, the daughter on the other end of the phone immediately became nervous, "Is she okay now?"

"Her blood oxygen saturation is relatively low. In order to prevent more serious problems, we intubated her first." Sun Lien said, "At present, her condition is relatively stable, and there are no other problems."

Sun Lien told a lie. He didn't mention that the blood oxygen saturation of the patient's prone position ventilation did not improve, nor did he mention the little "bribery" of the pot of lotus root ribs soup.There have been three good news today, and he wants to make this relaxed mood last a little longer - don't think about those bad things anymore.

"Doctor, I beg you, please save my mother." On the other end of the phone, the woman cried miserably, "My father passed away this afternoon, and my husband and I have also been quarantined...Doctor, I beg you Please, please save her, I only have her left!"

Sun Lien took a deep breath, "Don't worry, we will do our best to cure..."

Sun Lien made this call for 20 minutes.

After hanging up the phone, he leaned back in the chair silently, without moving for a long time.

Life is bitter, coming and going in a hurry.In the past few years as a doctor, Sun Lien has seen many lives and deaths.The first patient to be sent away... His memory is already a little fuzzy, he only remembers the bloody sun that day, and the cigarette he squatted in the parking lot and smoked.

The bitterness in his mouth slowly spread, and Sun Lien felt as if he had returned to that afternoon again.Since he had the status bar, he has always felt that he has a certain mission on his shoulders—the mission of alleviating the pain of patients and saving their lives.But after the phone call, he felt in a trance that he was still the same Xiaogui Pei who had just entered the emergency department for three months.Powerless, helpless, all confused.

A pair of gentle arms wrapped around his shoulders, and Hu Jia said to Sun Li'en, "I heard what you and your family members called just now."

Sun Lien patted Hu Jia's hand. There was no one else in the office, and he was not the director of a department or the leader of the treatment team at this moment.He is just an ordinary person who is too tired to stand up, "Am I useless?" Sun Lien had expected that Hu Jia would comfort him, but he couldn't hold back the words in his heart, "I tried my best , and brought hundreds of people to Yunhe to fight desperately, but in the end... none of them could be rescued."

"No doctor can save all the patients. If you are useless, then all the doctors in the world are useless." Hu Jiarou said, "My vision is good, you are not allowed to speak ill of my man!"

"Okay, okay, let's not talk about it." Sun Li'en smiled, and stood up from the stool, "Come on, let's work harder for that pot of pork rib soup!"

(End of this chapter)