Liu Tangchun looked a little nervous as he watched the throat swab bottle being sent out of the clean room.

According to the current regulations, if the anonymous person is diagnosed with avian influenza, and the case in the second hospital is also confirmed. Song Ontar province will have to enter the province's second-level response mechanism, and the fourth central hospital, which will be the receiving hospital, will also be closed and thoroughly disinfected as an epidemic site.

The main reason why the emergency room of the Second Hospital is closed but does not affect the overall situation is because the Fourth Central Hospital is taking in patients. But if even the emergency department of the Fourth Central Hospital is closed, where should those patients who need emergency services go? The Fourth Central Hospital undertakes more than 30% of the emergency work and tasks in the entire region, and once the emergency department is forced to close due to the epidemic, there is no way to deal with the extra 30% of the emergency work - the emergency departments of other hospitals can barely absorb the additional patients brought about by the closure of the second hospital at most.

Faced with this situation, of course, Comrade Liu was nervous to death. In the event that the emergency department closes, who knows how much the emergency department will have to be deducted in the next fiscal cycle!

The staff of the hospital entered the clean room wearing positive pressure protective clothing, and first put Xu Yourong into the protective clothing they brought. Both Xu Yourong and Zhong Yu, who had direct contact with the patient, will be sent to a fever clinic ward for quarantine observation until infectious disease experts confirm that she does not have symptoms of avian flu.

"Let you be a hero. Liu Tangchun clasped his hands to his chest and glared at Sun Lien, "How does it feel to be trapped inside?"

Sun Lien wore a mask and spread his hands towards Liu Tangchun, "Teacher Liu, you forced this treatment team into me." Now that this is happening, I can't shrink back."

"You still have a hard mouth," Liu Tangchun was ready to scold as soon as his eyebrows twisted, "When you were in school, the teacher didn't teach you, protect yourself first, and then you can help others!"

"I'm not wearing a mask," Sun Lien laughed twice, "Don't worry, it's not that mysterious." ”

An old man and a young man were fighting across the door, and the doctor next to him rolled his eyes when he heard it. After the laboratory department sent the results of Anonymous's examination, the hospital doctor was slightly relieved. Anonymous's five tests for infectious diseases were all negative, and it seems that at least Xu Yourong does not need to worry about the impact of other infectious diseases - just observe and observe avian influenza.

"Look, you're lucky. Liu Tangchun took the checklist to Sun Lien and looked at it, so that Sun Lien was also a little relieved, and then asked, "How is the patient?"

"To be honest, not very good. Sun Lien turned to look at the status bar, "After sputum suction, the blood oxygen concentration has temporarily risen a little, and now it is only 91%. I suggest that imipenem cilastatin sodium be discontinued and replaced with peramivir injection. ”

Liu Tangchun knew that Sun Lien was asking for his consent. Xu Yourong was isolated, and Sun Lien could only use his prescription rights.

Liu Tangchun pondered a little and nodded in agreement with this suggestion. "Now that imipenem has been used, let's finish it. ”

"Didi, Didi. The cardiopulmonary monitor barked again. Sun Lien hurriedly ran to the bedside. "Anonymous" Wu Fenmei's blood oxygen saturation began to drop again. "Intubation!" Sun Lien immediately decided on the direction of rescue, the patient is currently breathing pure oxygen, and the blood oxygen saturation has dropped again, indicating that the patient's own respiratory function is failing. Oxygen and non-invasive positive airway pressure machines alone cannot reverse the situation. The advanced airway must be opened immediately and the patient on a ventilator to maintain normal vital signs.

Usually in the rescue room, there are many doctors and nurses who can help rescue, but now there is only Sun Lien alone in the entire clean room. Liu Tangchun reacted very quickly, and as soon as he heard Sun Lien's voice, he was ready to put on protective clothing to help. But how can the positive pressure protective clothing brought by the hospital sense department be so easy to put on, and it will take two or three minutes to get ready, to say the least, with the assistance of two people. Liu Tangchun scolded while dressing, "The funds you usually want to come are fed to the dogs, what are you doing with P4-level protective clothing, you have ah, the patient inside is a bird flu, and it's not fucking smallpox!"

Sun Lien couldn't hear Comrade Liu's scolding voice. He was trying to insert a throat into Wu Fenmei's body. She was in a bad condition, and as soon as the laryngoscope was removed, a steady stream of pink phlegm poured out from the depths of her throat. The narrow field of view provided by laryngoscopy is almost instantly covered by sputum. Sun Lien held the medium-sized throat and could only barely lean down from memory. Fortunately, the intubation was successful, otherwise if he really had to do pharyngeal incision and intubation, Sun Lien was really worried about his lack of experience.

"Director Liu, you don't need to come in. Sun Lien shouted out the door, "The tube is plugged in!"

"If you have the ability, shout early. Liu Tangchun pushed open the door and walked in. The positive pressure suit itself resembles an inflated doll costume. Relying on the gas cylinder behind it, the internal pressure of the positive pressure protective suit is always slightly higher than the outside. In this way, even if the protective clothing itself is damaged, the positive pressure can ensure that for a short time, external pathogens cannot enter the protective clothing.

In general, only the highest-level P4 biosafety labs will be equipped with this equipment, and not just because the suits are expensive. What's more, without an external inflatable port, this suit would not have lasted long with a knapsack cylinder alone. Moreover, the Fourth Central Hospital itself did not have a P4 chemical disinfection spray room. It can be said that such protective equipment does not fully play its due role, but is troublesome to use. It is no wonder that Liu Tangchun is so dissatisfied with the hospital infection department.

"You think we bought this thing," Bi Tianhua, the director of the Academy, jumped outside the door, "I borrowed these sets of equipment from the biology laboratory of the college with my face in mind!"

"Look at you like that. Liu Tangchun turned around and said disdainfully to Director Bi Tianhua outside the door, "I don't know how easy it is to dig the corner of the wall!"

Ignoring the threat of the director of the hospital's office "I'm going to come in and kill you", Liu Tangchun turned his head to look at the "anonymous" Wu Fenmei on the hospital bed, and asked Sun Lien, "How is it?"

"Looks okay. Sun Lien glanced at the monitor, "The blood oxygen concentration has reached 93%." ”

"After a while, when the people from the hospital come in, you can also go to quarantine. Liu Tangchun looked at the mask on Sun Lien's face and breathed a sigh of relief. N95-level masks are still sufficient to protect against avian influenza. Just disinfect it carefully and isolate it a little more. At present, avian influenza is mainly transmitted from poultry to humans, and human-to-human transmission has not yet occurred. In contrast, avian influenza is significantly more "mild". Although the mortality rate is as high as 30% or more, at least it is not so violent.

Liu Tangchun's kindness was rejected by Sun Lien. "You should be a young man, let me continue to deal with it. Of course, I don't have anything to say if I transfer people to other hospitals for treatment later, but since people are in our hospital, and our hospital implements the first diagnosis responsibility system. That Xu Yourong was isolated, and this patient should be handed over to me to continue to deal with. ”

This is the reason that Sun Lien used to persuade Liu Tangchun, but for Sun Lien himself, there is actually only one reason for him to insist.

When avian influenza progresses to the point of severe pneumonia, the patient's condition can be very extreme and changeable. Having a status bar means that he can detect problems earlier than other doctors, and he can find the problem and intervene in time before other doctors wait for the results of the laboratory department.

And if you can do this kind of thing, I'm afraid there is only Sun Lien in the world. Since this patient has touched his hand, do your best to do it. At least don't leave yourself with regrets, thinking, "Ah, if only I had stayed and continued to treat her." That's what Sun thinks.

"You kid is making a fool of yourself. Liu Tangchun glanced at Sun Lien, "You are not married, you have no children, and you are not a party member, this kind of thing is not your turn......"

Just when Liu Tangchun was about to reject Sun Lien's request, the cardiopulmonary monitor called for the third time. Sun Lien and Liu Tangchun looked behind them together. It's just that Liu Tangchun looked at the monitor, but Sun Lien first glanced at Wu Fenmei who was lying on the bed.

"Wu Fenmei, female, 57 years old, H7N9 avian influenza infection, severe pneumonia, refractory hypoxemia, hypercoagulant state. ”

What Liu Tangchun saw was the rapid drop in Wu Fenmei's blood pressure on the cardiopulmonary monitor. From the initial 150/90 direct cliff drop to the 80/45 danger level.

"Director Liu!" Sun Lien shouted at Liu Tangchun, "Look at her hands!"

Patches of purpura appeared on Wu Fenmei's arm, and blood began to seep out of the area where the intravenous infusion needle was pierced. Although the amount of blood oozing is not too much, it must not be too small - Liu Tangchun lifted the quilt that was half covered on Wu Fenmei's arm, only to find that the blood oozing from the needle had stained a large sheet red.

"Purpura skin, bleeding tendency, rapid drop in blood pressure......" Liu Tangchun gasped, "This is DIC (disseminated intravascular coagulation)." ”

Liu Tangchun looked at Wu Fenmei's eyes, as if he was looking at a dead person. Although he immediately asked the doctors on call outside to send heparin, even Sun Lien knew that Wu Fenmei's condition was so critical that it was almost hopeless.

There may be a variety of causes of diffuse intravascular coagulation. It may be a circulatory disorder caused by shock, systemic clotting due to severe pneumonia caused by avian influenza infection, or even a coagulation reaction triggered by prolonged bleeding from the upper respiratory tract. In short, the cause of this symptom is no longer important. If DIC is not reversed as soon as possible, Wu Fenmei will soon die.

The treatment of DIC is also difficult because of the extreme two-sided nature of this symptom. There are two main symptoms of disseminated intravascular coagulation, the first is clotting and the second is bleeding.

When these two extreme contradictory situations arise in patients at the same time, it is the doctor's turn to start having a headache.