I can see the status bar

Chapter 995 D-day (6)
After frustratingly finding that the status bar was not very helpful to the current batch of patients, Sun Lien's mood was only depressed for a few seconds.

He has made dozens of versions of the plan that the status bar may be invalid or invalid. It can even be said that ever since he discovered some special abilities, Sun Lien has been preparing to lose this special plug-in one day.

Things that are not yours are unreliable after all, they can appear suddenly and disappear one day if they are not kept in order.No doctor would rely entirely on his career and the life and health of his patients on a cheat from an unknown source and how long it would last.At least have a backup plan.

In the face of this group of patients, Sun Lien's backup plan is very simple - to treat with heart.

Unlike ordinary wards, Dr. Qi Jing obviously followed the practice of intensive care medicine during the treatment process.The peripheral channels of the patients are very sufficient, and all critically ill patients are given central venous infusion chambers.

In order to facilitate the continuous detection of blood gas indicators in the patient's body, they put an arterial indwelling needle on each patient's leg.The summary of the patient's data is also very detailed. In addition to the daily data record, you can even see the record curve chart formed by the patient's various indicators on the computer.

Five doctors and seven nurses, taking care of patients with 48 beds, can provide such detailed information. Apart from admiration, Sun Lien's biggest idea is to learn from others—at least learn from Dr. Qi's attitude.Treat every patient with heart.

For Sun Li'en, it's not difficult to pay attention.The difficulty lies in which direction to use the heart, and... whom to use the heart on.

At present, there are three patients who need more attention.

7床是个74岁的老人家。1月3日发病，8日入院就诊。中间经历了三次转院，目前已经在传染病医院内接受治疗了十一天。现在正在使用气管切开机械通气辅助呼吸，俯卧位。血氧饱和度在92%左右。

This old man surnamed Shen was listed by Sun Lien on the list of needing attention for two main reasons. The first is his age—the 74-year-old Mr. Shen is currently the oldest patient living in North Fifth District.

The second reason is that his condition is very serious.

After tracheostomy and mechanical ventilation, the blood oxygen saturation is still only 92%, which is a standard critical illness.More dangerous are his CT scan results and other indicators.

As a patient with high blood pressure, cerebral infarction and type 210 diabetes, Mr. Shen's blood pressure was as high as 75/38.9 at one point, and his high fever of 133 degrees Celsius had lasted for four days.At its peak, his heart rate reached [-] beats per minute, and his inflammatory markers were also frighteningly high.

Two days ago, Mr. Shen was sent to the third floor for the second CT scan of admission.Compared with nine days ago, his lung lesions progressed very rapidly.On his CT image, his lungs are two completely white shadows - commonly known as "white lungs".This shows that his lung disease has developed to the whole lung.

The method of tracheotomy and mechanical ventilation is already the highest level of life support in the North Fifth District where Sun Lien is located.If there is another change in his condition... then Sun Li'en will be completely helpless.

第二个需要注意的是41床。这名姓彭的66岁男性患者12日发病，21日入院。目前同样正在使用气管切开加机械通气维持治疗。但他的生命体征要比沈老爷子好一点——他目前的血氧饱和度是94%。

但从炎症指标和免疫水平的角度上来看，彭大叔的情况比沈老爷子还要糟糕的多。他的淋巴细胞绝对计数只有0.19*10^9个/L、CD3+计数为112/μl、D-二聚体水平高达3785ng/ml、IL-6水平在206pg/ml，C反应蛋白水平更是高达193.4mg/L。

Such a high inflammatory index and such a low lymphocyte count can only show that a serious inflammatory storm is taking place in Uncle Peng's body.But his body temperature was a normal 36.8 degrees Celsius.

At the same time, because of hypothyroidism and stage II liver cancer as underlying diseases, the treatment of Uncle Peng also needs to take into account the adjustment of endocrine function and the impact of tumors... Treating Uncle Peng is not only urgent but also very difficult.

The third person who needs attention is Sister Pan, a 19-bed female patient.Sister Pan, 57 years old this year, was the head nurse of the emergency department at Nanhu Branch of Yunhe Central Hospital before being infected.She became ill on the 15th and was admitted to the hospital the day before yesterday.According to the records in the case, Sister Pan should have been infected by her husband at home.Her husband, father, father-in-law, mother-in-law, and 21-year-old daughter were all diagnosed.Her father and father-in-law have passed away, and her mother-in-law is currently receiving treatment in the ICU of the High-tech District Branch of Tongde Hospital.Sister Pan's husband and daughter are currently self-isolating at home, and the situation is unknown.

When Sister Pan was admitted to the hospital, there were large ground-glass opacities in both lungs, and her body temperature was 37.1 degrees Celsius, which was not very high.But what is more worrying is her significantly accelerated heart rate - 127 beats per minute is still tolerable for a healthy person, but Ms. Pan, who has undergone coronary artery stents and has type [-] diabetes, is not necessarily Can handle such a fast heart rate.

Since the blood oxygen saturation is only 88% when not inhaling oxygen, Sister Pan is currently using a positive pressure ventilator to assist her breathing.Her blood oxygen saturation can barely maintain around 93% now.

Unlike the other two critically ill patients, Sister Pan is relatively young and relatively in better physical condition.She seems to be more "resistant" than the other two.And the current situation seems to be better.

From a doctor's point of view, Sister Pan's treatment effect seems to be better than that of Mr. Shen and Uncle Peng.

"Director Ma, come to pick up Uncle Peng." Sun Lien made a decision after going around, "Uncle Peng's inflammation index is very high, adjust the hormone to 2 mg per kilogram of body weight and take a test. He doesn't have a fever, it should be No other bacterial infection - less risk with steroids."

Afterwards, Sun Lien called Chen Xuerong, who was from the Department of Cardiology, "You pick up Sister Pan. She is making rapid progress. Add up her interferon inhalation and increase it to twice a day at first. Monitor liver and kidney functions closely. If there is any change, , intervene as soon as possible."

Arranging Uncle Peng and Sister Pan out, Sun Li'en turned around and went to Mr. Shen's side.Looking at the 70-year-old old man who has fallen into a coma, Sun Lien sighed and muttered, "Old man, we are in the same boat now, you must hold on..."

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After working in North Fifth District for more than half a day, for the first time, Sun Lien had great doubts about the abilities of himself and the doctors in the Comprehensive Diagnostic Center.

If eight doctors and twelve nurses were so busy with 48 patients, how did Qi Jing and those four doctors and seven nurses survive?This unscientific!
Even if two more patients were admitted to the hospital, and one of them was rescued, this still could not explain Sun Lien's confusion.

Confusion is on the one hand, but on the other hand, Sun Lien also has a new understanding of the condition of these patients.

Every critically ill patient being treated is in a dangerous balance.Any small change may trigger a series of fatal continuous reactions.

Dr. Ma Yongfang switched to intubation and ventilation for Sister Pan in bed 19 at one o'clock in the afternoon. Sister Pan's blood oxygen dropped continuously from 93% in the morning to 91% under the positive pressure mask.Due to lack of oxygen, her heart rate rose further to 143 beats per minute.

This level of heart rate is very, very dangerous for a patient with a blood oxygen saturation of 91% and a history of coronary heart disease.Ma Yongfang's handling cannot be said to be wrong, but the accident still happened.

From the opening of the mouth to the completion of intubation, it takes about 5 minutes in total.Someone like Brunn who has been intubating almost his entire life can get that time down to almost 3 minutes.

During this time, doctors must be ready to terminate the intubation at any time, and then press the positive pressure mask back—at least to ensure that the patient's blood oxygen saturation is above 85%.

That was during the 5 minutes of intubation time, an accident happened.Just after the intubation was completed, Sister Pan's heart rate suddenly plummeted.It dropped directly from 143 beats per minute to 50 beats per minute.At the same time, the blood pressure also dropped rapidly, and the person was about to die.

"Fuck!" Bruen cursed angrily, threw away the intubation scope in his hand, and began to perform chest compressions.Attracted by this roar, Yuan Ping'an and others quickly started rescue work.After working for more than ten minutes, Sister Pan's heart started beating again after accumulatively using more than 15 mg of adrenaline.

"Just insert a tube?" Sun Li'en was completely confused about the patient's sudden cardiac arrest.Oral intubation of a patient whose blood oxygen saturation is always higher than 85% has been done in the emergency department for [-] or [-] cases.But there has never been a patient who has such a sudden cardiac arrest.

"Except for intubation, we did not receive any treatment." Dr. Ma Yongfang seemed to be in shock.When I was in the Department of Endocrinology, rescue was not a common job.And even when she came to the Comprehensive Diagnostic Center, she didn't experience this kind of thing many times.Fortunately, Chen Tianyang's "collapse therapy" had played a certain role in her before. After Sister Pan's heart stopped beating, she quickly realized that something was wrong, and found emergency medicine from the ambulance on the side.

Sun Li'en quickly looked at Sister Pan's status bar. Fortunately, no irreversible damage such as central nervous system damage appeared.

"It's not an option to go on like this." Yuan Pingan said from the side, shaking his hands like noodles, "We can't treat all intubations as high-risk medical solutions in the future, and there must be a rescue team on standby at any time, right?"

After observing Sister Pan's status bar for a while, Sun Li'en said helplessly, "Then what should I do? From now on, as long as the tube is intubated, at least three doctors will be on standby, and the operation can only be performed when the ambulance is in place."

In fact, it is not difficult to understand this kind of problem. After all, Sister Pan's blood oxygen saturation has been very low, and the continuous course of the disease has been depleting her heart's compensatory ability.Previous history of coronary heart disease means that her heart muscle has been damaged.Lost heart muscle cannot regenerate itself.This caused Sister Pan's heart potential to be much weaker than normal.

"It should have been intubated earlier." After much deliberation, Sun Lien could only blame himself in the end.He patted the shoulder of Dr. Ma Yongfang who was still trembling, "You didn't do anything wrong, this is not your problem."

(End of this chapter)