I can see the status bar

Chapter 1024 D+3 day (8)

Time passed by every minute and every second, and Sun Lien checked the patient's vital signs every 30 seconds at the beginning, then every 5 minutes, and then every half an hour.The frequency gradually decreased, and the spirit gradually became depressed.

No way, this feeling is too tiring.Although there is still a strong force supporting him to continue to pay attention to the changes in the patient's vital signs, he really feels that he can't hold on anymore.

The time has come to four o'clock in the morning on the 28th. This time period is the most sleepy time of the day for people.The other doctors couldn't bear it anymore, so they just fell asleep on the chairs in the office wearing protective clothing.And Sun Li'en decided to take a look at it again—sleeping when his breathing is not smooth, not only will he not feel refreshed when he wakes up, he may even be more tired and sleepy.

Of course, for the vast majority of doctors, it's okay to sleep if they can't bear it anymore. Anyway, the head of the department will support it when the sky falls.Sun Lien himself also encouraged other doctors and nurses to take a break. Although they can't help much with the adjustment of the treatment plan or research, they usually take care of patients, implement the treatment plan, record the patient's response to the treatment, etc. Complicated and indispensable The work is done by them alone.

From various angles, they worked very hard—even harder than Sun Lien.

Director Lu and Professor Li usually sit in the duty room in the yellow area outside because of their age.Relying on the monitoring and life monitor data from the outside, they remotely commanded colleagues in the red zone to carry out rescue work through walkie-talkies.And Sun Li'en... On the one hand, because of his youth and good health, and on the other hand, because of the job requirements on the status bar, he is the only third-line doctor who has been in the red zone.

It is always beneficial to go directly to the field.For example... Sun Lien saw some strange things in the ongoing bronchoscope flushing.

Generally speaking, what the bronchoscope washes out is mainly very viscous sputum or blood clots.But...the stuff that came out of Sister Pan's bronchus...it looked a bit oozing.

The doctors watching the flushing of the bronchoscope looked at what was washed out and let out an exclamation.

It's a mixture of dead tissue and phlegm and blood clots.Its nature is not very strange, but what is strange is the shape of this "phlegm plug".

"This is the outer basal segmental bronchus, and the above point should be connected to the lower lobe of the left lung..." Several doctors identified it for a long time, and then recognized their source from the shape of the "branch" sputum plug.

This is a phlegm plug from the lower left lung.The sputum mixed with a large number of inflammatory cells and necrotic and exfoliated mucosal epithelial cells almost became solid, and quickly "grow" and spread along the shape of the bronchi, and finally formed a "emboli" that blocked the bronchi.

"Phlegm suppositories usually appear when you have a bacterial infection or chronic bronchitis, right?" Sun Li'en hesitated, and he checked Sister Pan's status column again and again, but there was no hint of bacterial infection in this pile of statuses. .Sister Pan's blood indicators and other conditions do not support the hypothesis of bacterial or fungal infection.

"The DNA produced by the destruction of a large number of inflammatory cell nuclei can also increase the thickness of sputum." The respiratory physician who performed the bronchoscope flushing packed up his things and said to Sun Lien, "These patients are on a ventilator, and they really lack sputum. ability."

"That is to say, should we add some phlegm-reducing medicine?" Sun Lien frowned and pondered for a while, and then found that his little knowledge of respiratory medicine was not enough, "But the patient is now using mechanical ventilation, even if the sputum Diluted, still can't cough out."

"I have to suck the sputum routinely. And I have to be watched all the time. If the state is not right, I will suck the sputum immediately." The doctor in the Department of Respiratory Medicine thought about it and said, "It's hard to say how many times a day, but I see this situation... …Ten or eight times a day is not too much.”

Sun Li'en was a little hairy when he said this, suctioning phlegm was a high-risk operation.During the suction process, there is likely to be a large amount of virus-containing aerosols polluting the air, which directly hit the face of the doctor performing the suction.Therefore, doctors need to take the same protective measures as when performing endotracheal intubation-use positive pressure masks to protect themselves.And this kind of work requires not only the doctors themselves to operate, but also the cooperation of nurses and other doctors. At least two or three people should form a team to treat patients more safely.

That is to say, if you start routinely performing sputum suction or even bronchial endoscopy to remove sputum plugs, you will consume at least eight to twelve positive pressure masks per day.

This consumption is unbearable for North Fifth District, which is using industrial protective clothing.They distribute a total of three positive pressure breathing masks every day—one mask for each class.

Positive pressure breathing masks should be left in the red zone, and it may be feasible for medical staff to continue to wear the original N95 masks when disinfecting the masks regularly and wearing them.But the safer way is naturally to find a way to let other patients actively expel sputum, so as to reduce the probability of sputum forming sputum plugs.Thereby completely reducing the frequency that doctors need to actively perform sputum suction operations.

The implementation of the specific plan still takes some time to form.Sun Li'en himself is not a good expert in respiratory medicine or severe disease, so Professor Li and Director Lu have to touch the norms in this area to be at ease.

However, the benefit to the patient of suctioning and removing the sputum plug is immediate.After taking out the sputum plug, Sister Pan's blood oxygen saturation quickly rose by 5%, and has now stabilized to about 97%.

After giving Sister Pan 400mg of tocilizumab, Sun Lien and others withdrew from the ICU ward.All those lying here are critically ill patients who have been mechanically ventilated, and the risk of transmission in the ward is much higher than in other wards.The purpose of setting up remote monitoring here is also here - such a configuration can allow doctors and nurses to minimize the number of times they enter the ward.

The next question is, who will use the 200ml of convalescent plasma.

In all fairness, no matter what stage the epidemic is at, plasma from convalescents must be one of the most precious resources.In the early stages of the epidemic, it was simply impossible to obtain enough serum.In the middle and late stages of the epidemic, it is still a very difficult task to obtain enough serum to treat a large number of patients-this time the new coronavirus seems to have a soft spot for middle-aged and elderly people.Among these middle-aged and elderly patients, even if a large number of patients are cured, not much serum can be collected in the end.

Before the artificial monoclonal antibody produced by the research appears and can be widely used, the serum of the convalescent may be the best "specific drug".

As for who should use this best-used and extremely difficult-to-obtain special drug, Sun Lien was a little tangled.

If it is an ordinary doctor's way of thinking, this drug should undoubtedly be used for the most seriously ill patients.They need this special medicine the most.

In North Fifth District, the most serious patient is Mr. Shen.It has been the second day since he was connected to ECMO. Although the current vital signs are good, other indicators are not ideal after several checks.Now he has been treated with triple therapy of tocilizumab, CRRT and gamma globulin.But the specific effect will have to wait and see.

And even if Mr. Shen recovers and is discharged from the hospital... it is impossible for him to become a donor of convalescent plasma.

What if this blood plasma is transfused to other patients?It's not that Sun Lien hasn't thought about this issue.However, if the starting point of "patients can donate plasma after recovery" is considered, only the 11-bed Brother Qian can apply for the recovery plasma.

After he has received triple therapy, it will be a very important reference indicator.And Sun Li'en personally feels that even if Big Brother Pan doesn't use plasma, his chances of recovering from health are the highest in the entire North Fifth District.

For whom to use the plasma from convalescents? This has become Sun Lien's biggest headache now.

To be a pure doctor is to stand on a higher level and focus on the overall situation.This kind of conflict made Sun Lien feel like his headache was about to burst.

(End of this chapter)