Ningyuan, the Fourth Central Hospital, is brightly lit, and the patients and their families who come to see the doctor are still anxiously waiting for the doctor's treatment as usual.
"It's low again?" Liu Tangchun was so busy today that he was sweating. He had already changed three T-shirts. The City's Second Hospital, which is closest to the Fourth Central Hospital, received a suspected case of avian influenza today from a suburban chicken farm.
A staff member was unconscious with a high fever, and at the same time there were reports of a large number of poultry deaths in the chicken farm. The Ningyuan City Center for Disease Control and Prevention sent the staff member to the fever clinic of the emergency department of the Second City Hospital, and then directly closed and quarantined the Second City Hospital.
The emergency department. This caused the pressure on the Fourth Central Hospital to increase a lot. And "coincidentally", the Fourth Central Hospital also received a lot of seriously ill patients today.
What Liu Tangchun is busy dealing with is the third patient with fulminant myocarditis who was sent to the hospital today. Among the first two patients, the one in the most critical condition has been connected to ecmo (extracorporeal membrane oxygenation), and
Another ecmo machine is working in the ICU. There is only the last set of ecmo machines that can be used immediately in the Fourth Central Hospital.
A set of machines, and there were two patients with fulminant myocarditis in front of him. Liu Tangchun was so anxious that he almost cursed. He finally stabilized the conditions of the two patients with the doctors from the Department of Critical Care Medicine and the Department of Cardiology, but he could not relax just now.
Not long after, bad news came from the emergency room. One of the patients' heart rate dropped again.
"Have you arrived in the capital?" Liu Tangchun picked up his white coat and was about to run to the emergency room. Before he could reach the door, he saw Liu Pingchuan wandering over with his hands behind his back. "What are you doing here? You have to get off work.
?”
"Next thing." Liu Tangchun angrily bypassed Liu Pingchuan and walked quickly towards the emergency room, "Three cases of fulminant myocarditis! There is only one ecmo left in the hospital that can be used, how do you expect me to get off work?
?”
Liu Pingchuan has long been used to Liu Tangchun's fiery personality. He quickly followed Liu Tangchun and explained, "The hospital bought a total of three ecmo's at the beginning, and two of them are allocated to your emergency department. The critical care unit is
You’ve looked for me many times, but I’ve still left them all for you, haven’t you?”
"If you don't leave ECMO to me, will you put it out of your mind?" Liu Tangchun snorted twice, "Why are you following me? I didn't ask you to come for a consultation."
Liu Pingchuan smiled, "Didn't I just listen to Lao Zhu from the association saying that he plans to send his students to our hospital to study..."
"What old pig? Is there something about the second senior brother here?" Liu Tangchun pretended to be confused, "Why can't I understand?"
After all, they want to recruit people from Liu Tangchun. Liu Pingchuan's attitude is not ordinary, and his mentality is also extremely good, "Zhu Minhua's student, that young man named Yuan Pingan."
Liu Tangchun hesitated for a few words, almost reaching the door of the emergency room, and then said directly, "Zhu Minhua has already agreed with me to let Yuan Pingan come to our emergency department to learn more about Xiao Xu and Li En. Besides,
Well, Yuan Ping'an has a doctorate in emergency medicine, so it's not like he is a neurosurgeon like you."
"Yuan Ping'an planned to take my Ph.D. exam back then." Liu Pingchuan sighed and braced himself to explain, "As a result, I suddenly decided to come to Ningyuan that year. In the end, I had no other choice, so I entrusted him to
Zhu Minhua. Now that they are chasing us all the way from the capital to Ningyuan, it will be unjustifiable if we delay any longer, right?"
Liu Tangchun opened the door of the emergency room, "I don't care about this. Anyway, he is now the chief resident of the emergency department, and he who comes to Ningyuan is also my person!" He rushed into the emergency room with a sudden stride and began to observe the patient's condition.
"Tell me about the situation. Who is in charge of the bed?"
Liu Tangchun was dealing with the situation urgently, and Liu Pingchuan could only hold back his words even if there was a serious matter. There happened to be two patients suspected of spinal concussion in the emergency room. Since Liu Pingchuan appeared in the emergency room, then
The doctors in the emergency department happened to invite the vice president for a consultation. Anyway, they had not had time to call the doctors outside the hospital to assist. Xu Yourong was not in the hospital now. With the mentality of "no use, no use", he took charge of these two
The patient's attending doctor, Cao Yanhua, simply put the CT scan that had just come out into Liu Pingchuan's hand, "Dean Liu, please take a look at this..."
Liu Pingchuan frowned and looked at the CT scan. He had just finished watching the first film and confirmed the diagnosis of spinal concussion. Liu Tangchun was in chaos. The patient who received iabp (intra-aortic balloon counterpulsation) circulatory support had a sudden attack.
Myocardial infarction, Liu Tangchun directed the doctors to start rescue operations.
"Charge, 150 joules, get out of the way!" Nurse Zhong Yu rushed over with a defibrillation paddle. Two electrode pads were placed on the patient's right front chest and lower left ribs. After confirming that everyone had pushed away enough,
Nurse Zhong pressed the defibrillation button.
"It's still ventricular fibrillation, intubate first! Bring 150 amiodarone and inject it intravenously according to the flow rate for one hour. Lidocaine 50 mg should be injected intravenously!" Liu Tangchun threw away the white coat he was holding in his hand.
The man knelt beside the bed and began to perform cardiopulmonary resuscitation, his gray hair rising and falling with the pressure on his body.
"It's done!" Cao Yanhua rushed over when Zhong Yu was defibrillating. When Liu Tangchun was doing cardiopulmonary resuscitation, Cao Yanhua was already using a laryngoscope to intubate the trachea. When Liu Tangchun pressed the button for the twelfth time,
Cao Yanhua has completed tracheal intubation. He has withdrawn the tracheal tube and connected it to the ventilator.
"Second defibrillation, charge 180j, get out of the way!" Zhong Yu started the second defibrillation. But the effect was still not ideal. The patient's ventricular fibrillation state only disappeared for about 20 seconds, and then fell into ventricular fibrillation state again.
middle.
The person who fell into a state of ventricular fibrillation on the bed was a young child. His name is Zhang Kai, he is 16 years old and is a freshman in Ningyuan No. 2 Senior High School. When it snowed heavily in Ningyuan two days ago, Zhang Kai was out of class.
I spent an afternoon playing wildly on the playground with a group of classmates. When I got home, my clothes and shoes were all wet. After being scolded by my parents, I took a shower and put on clean clothes. Unexpectedly
Zhang Kai developed a fever that night. At first, the parents thought it was just the child catching a cold and didn't pay much attention. Who knew that as the weekend passed, Zhang Kai's condition became worse and worse. On Monday, his parents ordered him to wear a mask to school.
, and as soon as school was over in the afternoon, Zhang Kai was sent to the ambulance by the school teachers and he passed out.
In the Fourth Central Hospital, Zhang Kai was diagnosed with fulminant myocarditis. What has always worried Liu Tangchun is the condition of this young patient. Blood tests showed that Zhang Kai's creatine kinase index was as high as 1179u/l, and his muscle
The acid kinase isoenzyme was 150u/l. In addition, one day after admission, Zhang Kai's urine output was less than 100 ml. Liu Tangchun believed that the child might have acute kidney injury. So he was put on CRRT (continuous renal replacement therapy).
But the situation was still getting worse, and Zhang Kai once again fell into ventricular fibrillation. The third defibrillation, the fourth defibrillation, the fifth defibrillation, and finally, when the sixth defibrillation was carried out, his heart
His regular beating was restored. However, his blood pressure was alarmingly low, with systolic blood pressure of 45mm hg and diastolic blood pressure of only 30mm hg. His heart rate was about 90 beats/minute.
"The pupils on both sides are dilated, with a diameter of 7mm." Cao Yanhua checked Zhang Kai's pupils and shook his head, "Director Liu, this patient... is in trouble."
"What can we do?" Liu Tangchun, who had wet his T-shirt again, was in a bad mood. "He is only 16 years old. If our measures can be put in place, he can survive this test and can live like ordinary people in the future.
.Resist, even if you can’t resist. As long as we can bear it, there is hope for him.”
Taking advantage of Liu Tangchun's rest, Liu Pingchuan came over again and said, "Old Liu, please give me some face. At least let Yuan Pingan come to my place and learn from me for a while."
Liu Tangchun snorted from his nose, "You have also seen that there are so many things going on in my emergency room, and every patient is in danger. If I give him to you, where can I find such a vacancy?"
Liu Pingchuan was anxious, "Liu, please don't touch your nose or face! You have already taken Yourong to work in the emergency room..."
"Then let's take it as an exchange." Liu Tangchun quickly stood up and patted Liu Pingchuan's shoulder. "As long as Yuan Pingan is willing, I have no objection at all to letting him learn from you. In exchange, you will let Xu Yourong stay with you during this period.
I can work here with peace of mind." He smiled and pushed Liu Pingchuan out, "You also know that Takeda is going to donate a diagnostic center, so let Yourong take the lead when the time comes! Okay, I have something else to do here, so I'll talk about it first.
Here." As soon as he finished speaking, he pushed Liu Pingchuan out of the rescue room and closed the steel electromagnetic door.
Liu Tangchun was about to smile proudly when he heard the alarm sound of the cardiopulmonary monitor behind him. When he turned around, he saw that Zhang Kai had ventricular fibrillation again.
"Oh, I'm fucked..." Even though Liu Tangchun was well-informed, he couldn't help but cursed when he saw this scene.
The emergency rescue started again, and the doctors doing chest compressions had changed to three people. Everyone was so tired that they didn't even have the strength to speak. Even the male nurse Xiao Guo did a set of chest compressions, but the result was not good.
Good, not too bad. Although the patient still did not recover from ventricular tachycardia, at least he did not break Zhang Kai’s ribs.
"Go to autopluse. This is not the way to go." Liu Tangchun wiped the sweat from his head and took a look at the condition of another patient with myocarditis. Although it was not good, it was still stable. The rescue had been going on for fifty minutes.
, Zhang Kai recovered eight heartbeats, but each time did not last more than two minutes. If this continues, the only option is to use the ecmo system. But if the last set of ecmo is used, it means that another patient will once
If the same situation occurs, there is no way to save it.
Liu Tangchun subconsciously opened his mouth and called Zhou Jun, and then realized that his beloved disciple was resting at home. Zhou Xiufang's incident had a great impact on Zhou Jun. It was Liu Tangchun who made the arrangements for Zhou Jun's holiday. He was stunned, and then
He shouted "Li En!" and then suddenly shook his head and smiled bitterly. Sun Li En was visiting the capital for a difficult surgery. Counting the time, he might have just taken the high-speed train...
"Director Liu, did you call me?" The door to the rescue room was pushed open, and Sun Lien, wearing a new down jacket, carrying an old backpack, and two dark circles under his eyes, appeared in the rescue room. He looked curiously.
He looked at Liu Tangchun and pointed at the door of the emergency room behind him, "I just heard you calling me outside... so I came in."