Sun Lien hasn't seen a warning on the status bar for a month.
At around 4 o'clock this afternoon, the emergency department of Ningyuan Fourth Central Hospital received a family of three who came for treatment. All three people had high fever, severe headache, pain in their limbs, and coughed up a large amount of bright red bloody sputum.
.
The medical staff of the emergency center of the Fourth Hospital, who had just received avian influenza a month ago, did not even hesitate at all. They directly called doctors from the hospital's infectious diseases and infectious diseases department for consultation. They also quickly began to transfer the patients to the emergency room. The condition was really not good.
Those who could not be transferred were pushed with their beds to the emergency room, which the family of three did not have access to.
Although it is not yet certain what kind of disease this is, three members of a family fell ill at the same time, and showed obvious upper respiratory tract symptoms despite high fever. Before the province's secondary response mechanism was lifted, doctors from the Fourth Hospital immediately treated the three people
As a patient with a highly suspicious infectious disease, it is better to have a false alarm afterwards than to be careless and cause continued infection. What's more, looking at the course of these three people's illnesses, a very scary term appeared in the minds of the doctors.
plague.
Yuan Pingan was inspecting the emergency room at first. When he saw the three patients coming in, he immediately stopped the nurse who turned around and was about to leave, and announced that the emergency room was closed. With the assistance of other doctors, he completed the
Evacuate patients who were in relatively stable condition. Then he called Sun Lien.
"Their situation is too similar to the plague." Yuan Pingan said to Sun Li'en, "I just called Director Zhou and he agreed with my move to close the emergency room."
Yuan Pingan actually has no right to announce the closure of the emergency room. He must immediately notify Zhou Jun, who has the relevant rights, and obtain permission. At the same time, he must also notify his superior doctor. Judging from the current treatment team structure, he must immediately notify
Notify Sun Lien.
Sun Lien smiled bitterly. The words "Warning, high risk of transmission" and "Warning, high risk of fatality" were like small advertisements posted on telephone poles on the street. They were posted everywhere without restraint. Compared with the previous "warning, high risk of fatality"
"High risk of transmission" also adds "high fatal risk". The status bar almost clearly states that these three patients have serious infectious diseases. And the risk is much higher than that of bird flu.
"How is the patient's condition?" Although the disinfection and treatment can be left to hospital infectious diseases and infectious diseases, the emergency department's own work still has to be done by the emergency department. Rescuing patients and maintaining vital signs, these most important tasks cannot be done because of
Worrying about infectious diseases will cause delays.
"Sinus tachycardia, my son's heart rate is 148, both parents are at 151, and his blood pressure is a bit low." Yuan Pingan was reminded by Sun Lien, and then he realized that he had not done a basic physical examination on the patient. Fortunately, the nurse sister next to him
They were very capable and had already put monitors on all three of them.
"Draw blood and do culture." After all, Sun Lien has been Yuan Pingan's leader for more than a month, and he is very familiar with directing the rescue process. "Take a sample from each patient and send it directly to the city CDC."
After arranging this series of tasks, Sun Lien could finally take a look at the status bars of these three patients.
"Tang Xingde, male, 48 years old" "Hou Huiying, female, 45 years old" "Tang Wen, male, 22 years old".
There are five statuses neatly marked on the status bar of a family of three, and the earliest status time difference between the three of them is no more than 14 minutes, and the earliest symptom time is no more than 29 hours. It is basically certain that they were infected by a single source of infection at the same time.
of.
The five states are "significant increase in white blood cell levels", "high fever", "severe pneumonia", "sinus tachycardia" and "decreased fibrinogen concentration".
A significant increase in white blood cell levels, high fever, and severe pneumonia are all important indicators of bacterial infection. Sinus tachycardia may be caused by acute myocarditis or infection or fever. And the decrease in fibrinogen concentration, needless to say,
This is an old friend. Excessive reduction may cause DIC in the patient's body, and ultimately lead to the patient's death due to hemolysis and thrombosis.
"What's your body temperature?" Sun Lien put on protective goggles and gloves, and put on a one-piece protective suit. This is the defense standard for emergency patients with fever under the second-level emergency response mechanism. As for the mask, it's an N95 without a breathing valve.
Masks are now basically standard equipment in the four hospitals.
"41c." Yuan Ping'an also put on the same protective clothing, took the ice blanket from the nurses on the side, covered the three of them, and asked the nurse, "Where are the other family members? And
Are the family members here?"
"No, this family lives alone. They just returned from traveling abroad. The neighbor invited them to have dinner together at noon today, but they didn't wait for anyone to come. Finally, when I knocked on the door, I found that they were not in good condition, so I called 120 for help."
"Call the police, contact the Centers for Disease Control and Prevention, and ask them to isolate the neighbor immediately. Also, find out where they have traveled. Especially, find out whether they have been to a natural plague-infected area." Yuan Ping'an is still worried about the plague.
The problem may continue to spread. Song'an Province is not a natural plague area, and this family of three was most likely infected elsewhere. But nothing is absolute. If other pneumonic plague patients are infected and then spread to this family
People, that means there is another source of plague spreading outside the hospital, wandering around uncontrollably.
"Where have you been playing before? Have you come into contact with marmots, gerbils, or other rodents?" Sun Lien's approach was more direct. He patted Tang Wen on the shoulder and asked. Tang Wen's parents already looked a little indifferent.
Now, the blood oxygen saturation of the two people is dropping rapidly, and other doctors are intubating and rescuing them. Now is not the time to worry about the spread of infectious diseases, at least it is not Sun Lien's turn to worry about it.
"We went to Xihai Province... The reception there treated us to grilled marmot..." Tang Wen tried his best to answer the doctor's questions. He was young and knew more about this aspect than his parents. "
We also saw marmot skins…”
"When did you eat it?" Sun Lien was surprised and asked quickly.
Tang Wen trembled and covered his head. After breathing heavily for a few times, he replied, "The day before yesterday, we ate before we left."
Plague is a highly infectious disease that originates in natural plague foci. The disease is mainly spread through fleas. Animals naturally infected with plague can be used as sources of human plague infection. These include rodents, wild carnivores,
Wild artiodactyls, domestic animals, etc. The "marmot" mentioned by Tang Wen is full name "Himalayan marmot". It is a species endemic to the Qinghai-Tibet Plateau and is also the main reservoir host of plague in the epidemic areas of the Qinghai-Tibet Plateau.
This sturdy rodent can weigh more than ten kilograms. Its fur is of good quality and its meat is tender and delicious. In addition, it is relatively easy to catch and has a strong destructive effect on plateau pastures. Therefore, many herders will
Capturing marmots. On the one hand, they protect the pasture, and on the other hand, they use them for food and sell their furs for profit.
In addition to marmots, marmots, an "Internet celebrity animal" that has suddenly surged in popularity recently, actually have the risk of spreading plague. Sun Lien once saw pictures of tourists feeding marmots at close range. They looked beautiful, but Sun Lien
Looking at it made my back feel cold. If that marmot was infected with the plague, I'm afraid only one or two of the seven or eight tourists who went to feed the marmot would survive.
As a severe infectious disease, plague progresses very quickly and has a very high mortality rate. All three members of the Tang family showed obvious lung symptoms. If it is really plague, it is classified as pneumonic plague. Death
The rate is about 80%, and the course of the disease generally does not exceed five days. The time from initial symptoms to death from multiple organ failure is generally less than 72 hours, and it is highly contagious. Patients cough and spit out bloody sputum, and bacteria-containing bacteria are produced when breathing.
Aerosols are all sources of transmission.
"The colloidal gold used to diagnose plague is not available in the hospital. The samples have been sent directly to the Centers for Disease Control and Prevention. The results will be available in about 40 minutes." Xu Yourong was receiving information from all sources. This was a task assigned to her by Sun Lien, although she was already at the hospital.
After working in the emergency department for a month, Xu Yourong was still not particularly skilled in rescue. She could not help much in the treatment of such a severe infectious disease. Sun Lien thought about it and simply asked her to be responsible for communicating and coordinating rescue matters. From requesting consultation to
Drug preparation, from reporting to the CDC to assisting hospital staff in setting up an airtight door outside the emergency room door. In short, these busy and demanding matters were all left to Xu Yourong to handle.
Xu Yourong also lived up to Sun Lien's expectations. Her coordination skills were extremely impressive. She held three mobile phones and two landline microphones at the same time, and performed mixed WeChat voice and text input. Xu Yourong made no mistakes at all.
"There is no time to wait for the results." Sun Lien frowned and looked at the status of the three members of the Tang family. Tang Wen probably had the advantage of being young, but his parents were not so lucky. The heart rates of Tang Xingde and Hou Huiying
Both exceeded 160, and the systolic blood pressure was less than 100. Both of them are currently in a state of shock. The nurses opened four intravenous channels on the two people and are rapidly infusing glucose solution and crystalloid. Their condition is very bad.
No one knows how long the couple can survive under the full rescue efforts of the emergency room. "First take the medication according to experience and do a skin test to see if there is streptomycin allergy. If not... Inject two grams of streptomycin intramuscularly.
Ciprofloxacin 500 mg intravenously.”
"Doctor Sun, this is Dean Song's call." The doctor's orders had just been given, and Xu Yourong called Sun Li'en over to answer the phone. "Can you answer it now?"
"Dean Song." Sun Lien took the call. On the other end of the phone, Song Wen asked calmly, "Those three patients, do you suspect they are plague?"
Sun Lien responded, "The patient came into contact with Himalayan marmots in Xihai Province 48 hours ago and ate marmot meat. He currently has a high fever of 41c and severe lung symptoms. According to the diagnostic standards, it is a highly suspected case."
"I didn't ask about the diagnostic criteria, Sun Lien, I was asking you." Dean Song raised his voice a little, "Do you think these three people have plague? Could it be pulmonary anthrax?"
"The early symptoms of pulmonary anthrax do not have high fever, and they progress too quickly and are not completely consistent with the symptoms of anthrax. Considering the contact history, plague is the most likely." Sun Lien certainly did not dare to say that this was plague. He had never seen a living person.
What about plague patients?
Dean Song sighed, "Then follow the plague treatment first. I'm warning you, you are absolutely not allowed to take off your fucking mask again this time. Do you know that it will kill people?!"
"I know!" Sun Lien stood at attention unconsciously. He already knew very clearly how terrible hospital infection was and how terrible plague infection was. After the isolation was completed, he would never enter the isolation area without wearing P4 protective clothing.