Streptomycin is a commonly used first-line antibiotic in clinical practice. As an aminoglycoside antibiotic, it is low-cost and effective in fighting infections. The main reason why Sun Lien decided to use streptomycin and ciprofloxacin in combination is
This is based on the plague diagnosis and treatment plan promulgated by the National Health Commission in 2011.
As a guiding document for plague treatment in health institutions, the plan details the diagnosis method of the disease, the recommended dosage and type of medication, disinfection care and other arrangements. Within the allowable range, the maximum dose of streptomycin is injected intramuscularly, and
The combined use of ciprofloxacin is actually a very strong anti-infective measure. But Sun Lien is not sure whether this dose is enough. The symptoms of Tang Xingde and Hou Huiying are too severe.
"The results of blood routine, blood gas, liver function and kidney function came out. All three patients had decreased platelet count. Tang Xingde had acute liver injury and acute renal failure, and his wife had acute renal failure and metabolic acidosis." Xu Yourong.
She shouted to Sun Lien. She saw the inspection data in front of the computer. The paper inspection form was still being printed.
"Send the renal function data to Zhou Ce and ask for his opinion." Acute renal failure can range from mild to severe. Not every case of acute renal failure needs to be dealt with immediately. Things always have priorities. In life-threatening conditions
Next, the most important thing is to deal with the patient's respiratory and circulatory system problems first. Without kidneys, the patient may die within a few days. Based on the estimation that all three people were infected with plague two days ago, it is probably still a long time before Yersinia pestis takes their lives.
About a day. But without a respiratory and circulatory system, no one can survive for more than five minutes.
First deal with the respiratory and circulatory system problems, and then turn your attention to the plague. Finally, deal with acute kidney injury and liver damage. This is the correct treatment plan, the one with the best chance of survival for this family of three.
Save lives first, then treat illnesses.
"Streptomycin cannot be used. The patient has acute renal failure." Zhou Ce called the emergency room directly. He also knew that Sun Lien had received three patients who were highly suspected of plague. According to the Plague Regulation of the National Health Commission,
In the diagnosis and treatment plan, streptomycin is the first recommended treatment drug. However, patients who have shown impaired renal function need to avoid using streptomycin as much as possible. Streptomycin does not directly metabolize or react in the human body.
It depends on the kidneys for excretion. If the patient suffers from renal function damage, it is also the metabolism of t1/2, and the original metabolism speed of two hours will be extended to more than 100 hours. And the human body is exposed to a high concentration of streptomycin for a long time, which may
It will produce serious toxic and side effects. After Zhou Ce discovered this, he immediately called the emergency room. He estimated that Sun Lien was not particularly sensitive to this. "Cefpiramide can be used for treatment instead."
Cefpiramide is a third-generation cephalosporin antibiotic. Although there is relatively little data on the use of third-generation cephalosporins to treat plague, many drug susceptibility experiments have proven that Yersinia pestis is extremely sensitive to third-generation cephalosporins. It is sensitive
The efficacy is even higher than that of traditional anti-plague antibiotics such as streptomycin and gentamicin. More importantly, after intravenous injection of cefpiramide, the blood concentration increases faster than intramuscular injection of streptomycin, and it is mainly excreted through bile, which affects kidney function.
It can still maintain good metabolism under incomplete conditions.
"Cefpiramide, right? Got it. Do I still need to continue taking ciprofloxacin?" Sun Lien trusted Zhou Ce's suggestion very much. After all, his work experience is much richer than his own, especially under the condition of renal insufficiency.
Twenty Sun Lien bundled together have more experience in using medicine than a single hair of Zhou Ce.
"Pneumonic plague is a severe case, so it must be treated with a combination of drugs. Fluoroquinolones are fine, and combined with ciprofloxacin is no problem. Even if there are minors among the patients, it is better to not grow taller than to die."
Tang Wen was already an adult, so he was not afraid of the chondrotoxic effects of ciprofloxacin. Sun Lien adjusted the medication and breathed a sigh of relief after watching the nurses inject the medication into all three of them.
The next work mainly depends on the hospital's infectious disease department and infectious disease department. Of course, because it is pneumonic plague, the respiratory medicine department also needs supporting doctors to participate in the treatment. And the supporting doctors must follow the instructions of everyone within the hospital.
There are undeclared rules to choose from.
Party members, who are married, have children, and are not the only child are drawn in the first batch. They are arranged in descending order according to their level, and everyone draws lots together. Department directors have four lots, deputy directors have two, and attending and hospitalization are all in the same lot. After the lot is drawn,
, just make a phone call with your family and say a few words, and you have to immediately go to support and rescue people. This is the rule in the hospital for treating patients with high risk of infection. The doctors who are not selected will be selected as the second batch and one person will be selected as a reserve, just in case the first batch
If a batch of doctors who are drawn out are unable to continue to perform their duties due to...some reasons, then the second batch of doctors will take over.
In the face of probability, all beings are equal.
"Okay, okay, let's all get together and draw lots?" Huang Wenhui, the chief director of the Department of Respiratory Medicine, unceremoniously dispersed everyone who was preparing to draw lots. "What's so good about this? Just go and do whatever you have to do. I
Just go."
Director Huang is forty-three years old this year. He is not tall, only about 1.5 meters tall. But in the one-third-acre field of respiratory medicine, Director Huang is the one with the biggest rules. Not only does he have big rules, but he also has a big temper.
She has low eyelids, and the best way to deal with a mistake is to admit it before she notices it. If Director Huang discovers your mistake, it won't be something that can be overcome with just one or two sentences. According to Corey
Based on his experience, Director Huang can memorize the problem of "the content of the case record is not objective enough" for at least three years, and use it to teach those who make mistakes from time to time.
Such a serious person usually has poor popularity. Director Huang Wenhui is no exception. Anyway, according to the rules, Director Huang has four lots to draw, and everyone has no objection. But who knew that this time, Director Huang, who is not very popular, will do what he did.
made such a decision.
"What are you doing? Want to rob?" Director Huang is from Cantonese. He is dark, thin and short. He doesn't look like a person who has given birth to a child at all. "Let you people take care of plague patients, then what?
It's harmful to both others and yourself. You might even put the person to death." She glared, "Don't rob me if you don't have the ability!"
Everyone in the Department of Respiratory Medicine exchanged glances with each other. They were not sure whether Director Huang was really angry, or whether he was trying to make everyone accept the fact by saying this.
"I am the head of the department and a party member. My child is in junior high school and I have an older brother at home." Director Huang laughed and poked his hand at his waist. "Which one of you can beat me? Okay, get out of here and wait for me to come back."
Yes, I want to check the case!" After saying that, Director Huang turned around, walked out of the office in a cool manner, and walked towards the stairwell.
After making sure that no one was around, Huang Wenhui took out her cell phone with trembling hands and dialed her husband, her voice trembling as she spoke.
"There is plague, and I have to go for a consultation. You have to cook for the children these days." Director Huang's voice was shaking badly, "It's okay, I'm okay, I... I'm not afraid!"
In the year of SARS, Director Huang had just graduated from his undergraduate degree and entered the First Affiliated Hospital of Ningyuan Medical College. That year, the First Affiliated Hospital happened to be designated as the designated treatment hospital for SARS cases in Song'an Province.
"That's what Teacher Hou said that year. If he can do it, so can I... I can do it too!" After Director Huang said this, he hung up the phone resolutely. He wiped his eyes with his sleeves and stamped his feet.
Run towards the emergency department rescue hall.
"As a member of the Communist Party, I only have this privilege." Professor Hou Youning, who was the director of the Department of Respiratory Medicine at the First Affiliated Hospital of Ningyuan Medical College, said at the time, "When I can't do it anymore, you can draw lots again!"