The cardiopulmonary monitors equipped in the emergency room of the Fourth Central Hospital are brand-new equipment, and some even use disposable electrode patches with negative pressure adsorption. The purpose is to prevent skin damage that may be caused by adhesive electrode patches. damage.
However, black and red blood oozed out near the patch attached to Chen Wen's chest. If you look closely, you can even see adipose tissue exposed to the air, as well as curled and dead epidermal tissue.
"I'm going to get the debridement kit." Sun Lien was also a little panicked. He had never seen such serious skin damage. The sores were the size of coins. Even just glancing at them through his clothes made him feel nervous.
Chen Wen fell into a drowsy sleep under the influence of the medicine, and Shen Qingmei was so nervous that her face turned pale. She almost cried and asked, "What's wrong with her? What's going on?"
"Calm down first." Liu Tangchun winked at several nurses and asked them to go out first with Shen Qingmei, who was almost collapsed. He frowned, lowered his head and carefully observed the sores that were still bleeding. .
"Director Liu..." Sun Lien held the debridement bag and threw it over in small steps. Seeing Liu Tangchun lowering his head to observe the situation, he quickly put the debridement bag in his arms on the trolley next to him. He leaned over and whispered. Asked, "Is something wrong?"
Liu Tangchun glanced at Sun Lien and said, "What do you think is wrong?" His tone was kind, but he looked like he was ready to test Sun Lien.
Sun Lien looked at the status bar above Chen Wen's head. The hypercalcemia and hypercoagulation were still there, but the other conditions had not changed at all. It seemed that there was no special progress in the condition. He looked down at the patients who were obviously necrotic. She was a little confused about the sores, "We have already given her dexamethasone. Glucocorticoids will suppress her immune system, so it shouldn't be an allergic reaction to the electrode patch. Is it a side effect of the drug?"
"It should be." Liu Tangchun nodded, "Diseases that can cause multiple blood clots generally do not cause skin necrosis. Her symptoms before being sent to the hospital should not have this kind of situation. The most reasonable explanation is that we gave Her medication caused necrosis."
Sun Li'en looked at Chen Wen on the hospital bed and sighed, "I will stop her warfarin right now... But she has undergone coronary intervention therapy, so she cannot use dipyridamole."
"You are her attending doctor." Liu Tangchun said with a smile, "So, what should we do now?"
Sun Lien was silent for a while, quickly searching for other anticoagulant treatment options in his mind. The side effects of warfarin on Chen Wen were too severe. If the large necrosis could not be controlled immediately, the dead tissue would enter the circulation along the capillaries. Systemic infection may cause sepsis. If only heparin is used for anticoagulation, large doses of heparin will suppress Chen Wen's bone marrow function. Together with dexamethasone, the suppressed immune system will be unable to cope with the skin gangrene that has occurred. If the condition continues to worsen and the gangrene that appears above Chen Wen's chest extends downward and breaks through the abdominal wall, it is likely to cause necrotizing fasciitis.
Now, there is a dilemma. If the anticoagulant treatment is stopped, the blood clot will continue to increase and enter the lungs to cause pulmonary embolism or the brain to cause a stroke, which may directly kill Chen Wen. However, if heparin anticoagulant treatment is continued, it may This causes gangrene to continue to expand downward, forming necrotizing fasciitis, and leading to sepsis. In severe infection, Chen Wen will still die.
"Give her rivaroxaban." Sun Lien raised his head with firm eyes. "Stop warfarin and maintain heparin to see if the side effects of warfarin can be alleviated. Increase the dose of dexamethasone from 10
The mg was increased to 20 mg. Levofloxacin and ciprofloxacin were injected, the wound was strictly debrided, and then compound polymyxin was applied externally."
"A very determined anti-infection method." Liu Tangchun nodded. "That's it?"
Sun Lien was silent for a while, "Strengthen care and monitor the development of gangrene at any time. Once there are signs of breakthrough of the abdominal wall... perform resection."
"Where to remove?" Liu Tangchun asked, "How large is the range of removal?"
Under Director Liu's continuous questioning, Sun Lien could no longer cope. His silence became longer and longer each time, and his frown became deeper and deeper.
"You know the treatment plan." Director Liu suddenly said, "With such a decisive anti-infection plan, we even used ciprofloxacin, the ultimate anti-infection method. But you should know very well that the safest treatment plan is
What."
Sun Lien shook his head, almost pleading, "She is only ten years old, and the consequences of surgical removal of breast tissue will be too painful for her."
"Pain means that she is still alive." Liu Tangchun's voice also lowered, "Pain is evidence of life. If she died of necrotizing fasciitis, what is the use of the preserved breast tissue? Li En, you want
Remember..." Liu Tangchun looked directly at the young man in front of him, whom he particularly admired, with piercing eyes, "Our job is to save the dying and heal the wounded. Saving patients who are about to die and bringing them back from the gate of hell is our primary goal."
"At least... take another look." Sun Lien looked at Chen Wen who was lying on the bed. Her face seemed to be distorted by the constant pain in her sleep. "Heparin may be able to alleviate the side effects of warfarin..."
"She can still wait before the gangrene penetrates deep into the abdominal wall." Liu Tangchun sighed. "Let's notify the family first."
"You... want to remove..." Shen Qingmei opened her mouth wide, "No, no! I will never agree to it!"
"As a doctor, I don't want to do this even more than you do." Sun Lien understood the reaction of the young mother in front of him very well. He whispered, "The side effects of warfarin are very rare, but it did appear in Chen Wen's body.
.If the gangrene is not removed before it breaks through into the abdominal cavity, her life will be in danger."
Shen Qingmei covered her face and was silent for a while, then suddenly asked, "Can I be transferred to another hospital?"
"Her condition is not stable, and a hasty transfer may cause her blood clots to continue to move. If she is transported by helicopter and she develops a pulmonary embolism on the plane, there will be no way to deal with it." Sun Lien has also considered this issue, but in reality
The situation simply did not allow for transfer. "If transported by ambulance, it would take at least 10 hours. During this time... her gangrene is likely to transform into necrotizing fasciitis."
"How much time do I have before you...have to remove her breast tissue?" Shen Qingmei wiped away the tears on her face, "Can I invite experts from Beijing and Shanghai to come over and diagnose her?"
"Conservatively, I think there may still be about two hours." Sun Lien shook his head regretfully. "The time...may not be enough."
"I always have to do something for my daughter." Shen Qingmei took out her phone and walked out of the rescue hall, "Mr. Wang, I want to ask you for a favor."
This woman's figure looked extremely tall in Sun Lien's eyes.