The cardiopulmonary monitor equipped in the emergency room of the Fourth Central Hospital is a batch of brand-new equipment, and even some luxury disposable electrode patches with negative pressure adsorption are selected. The goal is to prevent skin damage that may be caused by adhesive electrode patches.

However, near the patch on Chen Wen's chest, black-red blood had oozed out. If you look closely, you can even see fatty 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 a serious skin injury. The sores the size of a coin, even if he just glanced at it through his clothes, made him feel a pang in his heart.

Chen Wen fell asleep groggily under the effect of the drug, 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?"

"You calm down first. Liu Tangchun gave a few nurses a look, and asked them to go out first with Shen Qingmei, who was almost collapsing. He frowned, looking down at the bleeding sores.

"Director Liu......" Sun Lien ran over with the debridement bag in small steps, and seeing Liu Tangchun looking down to observe the situation, he hurriedly put the debridement bag in his arms on the small cart next to him. Leaned over and whispered, "Is there something wrong?"

Liu Tangchun glanced at Sun Lien, "What do you think is wrong?" The tone was kind, but he looked like he was ready to test Sun Lien.

Sun Lien looked at the state bar on Chen Wen's head, the state of high blood calcium and high coagulation was still there, and the others had not changed at all. It doesn't seem like anything in particular has progressed in the condition. He looked down at the apparently necrotic sores again, and wondered, "We've already given her dexamethasone." Glucocorticoids suppress her immune system, so shouldn't it be an allergic reaction to the electrode patch, could it be a side effect of the drug?"

"It should be. Liu Tangchun nodded, "Diseases that can cause multiple blood clots, generally do not lead to skin necrosis." Nor should she have had symptoms before she was sent to the hospital. The most plausible explanation is that the drugs we gave her caused necrosis. ”

Sun Lien looked at Chen Wen on the hospital bed and sighed, "I'll stop warfarin for her...... But she has the talent to do cardiac coronary intervention, and she can't use Pan Shengding. ”

"You're her treating doctor. Liu Tangchun smiled, "So, what should we do now?"

Sun Lien was silent for a while, his mind quickly searching for other anticoagulant treatment options. The side effects of warfarin on Chen Wen are too severe, if a large area of necrosis is not controlled immediately, the dead tissue may enter the circulatory system along the capillaries, which may cause sepsis. However, if only heparin is used for anticoagulation, a large dose of heparin will inhibit Chen Wen's bone marrow function. Combined with dexamethasone, the suppressed immune system will not be able to cope with the skin gangrene that has already appeared. If the disease continues to deepen, these gangrene, which appeared above Chen's chest, are likely to cause necrotizing fasciitis once they extend downward and break through the abdominal wall.

Now, it's a dilemma. If anticoagulant therapy is stopped, the blood clot will continue to increase, and it will enter the lungs to cause pulmonary embolism or enter the brain to cause a stroke, which may directly kill Chen Wen. Continued anticoagulation with heparin may cause the gangrene to continue to expand downward, resulting in necrotizing fasciitis and sepsis. Under the severe infection, Chen Wen will still die.

"Give her rivaroxaban. Sun Lien raised his head with a determined gaze. "Stop warfarin, maintain heparin, and see if you can alleviate the side effects of warfarin. Increase the dose of dexamethasone from 10 mg to 20 mg. Levofloxacin and ciprofloxacin were injected, the wound was strictly debrided, and then applied externally with compound polymyxin. ”

"Very resolute means of fighting infection. Liu Tangchun nodded. "That's it?"

Sun Lien was silent for a while, "Strengthen nursing care and monitor the development of gangrene at any time." As soon as there are signs of a breakthrough in the abdominal wall...... Just do the excision. ”

"Where is the excision?" Liu Tangchun asked, "How big is the excision?"

Under Director Liu's continuous questioning, Sun Lien was already a little unable to cope with it. His silence grew longer and longer, and his brow furrowed deeper and deeper.

"You know the solution. Director Liu suddenly said, "With such a resolute anti-infection plan, I even used ciprofloxacin, the ultimate anti-infection method." But you should know exactly what the safest solution is. ”

Sun Lien shook his head, almost pleading, "She is only ten years old, and the consequences of surgical removal of breast tissue are too painful for her. ”

"The pain means that she is still alive. Liu Tangchun's voice also lowered, "Pain is evidence of life." If she dies of necrotizing fasciitis, what is the use of the preserved breast tissue? Lien, you have to remember......" Liu Tangchun's eyes were blazing, looking directly at the young man in front of him whom he admired very much, "Our job is to save lives and help the wounded. Helping patients who are dying and pulling them back from the door of hell is our primary goal. ”

"At least...... Observe again. Sun Lien looked at Chen Wen lying on the bed. Her face seemed to be slightly distorted by the constant pain that came from her sleep. "Heparin may alleviate the side effects of warfarin......"

"She can wait a little before gangrene penetrates deep into the abdominal wall. Liu Tangchun sighed. "Let's go and inform the family first. ”

"You ...... I want to cut off ......" Shen Qingmei opened his mouth wide, "No, no! I will never agree!"

"As a doctor, I don't want to do that more than you do. Sun Lien understood the reaction of the young mother in front of her. He whispered, "The side effects of warfarin are very rare, but it did appear in Chen Wen's body. If surgery is not performed before gangrene breaks through to the abdominal cavity, her life is in danger. ”

Shen covered his face and was silent for a while, then suddenly asked, "Can I transfer to the hospital?"

"Her condition is not stable, and a hasty transfer may cause her blood clot to continue to move. If she had been transported by helicopter and had a pulmonary embolism on the plane, there would have been no way to deal with it. Sun Lien also considered this issue, but the reality is that he does not allow for transfer to the hospital at all. "If you use an ambulance to transport, it will take at least 10 hours. During this time...... Her gangrene most likely converted to necrotizing fasciitis. ”

"In your ...... How much time do I have before I have to have her breast tissue removed?" Shen Qingmei wiped the tears from her face, "Can I ask experts from Beijing and Shanghai to come and diagnose her?"

"If you think it's a conservative estimate, it's probably about two hours away. Sun Lien shook his head regretfully. "Time...... Probably not enough. ”

"I always have to do something for my daughter. Shen Qingmei took out the phone and walked towards the outside of the rescue hall, "Mr. Wang, I want to ask you for a favor." ”

This woman's figure looks extremely tall in Sun Lien's eyes.

Ask for a referral ticket!