In the clean room, the chirping of three cardiopulmonary monitors sounds a little messy. Sun Lien and Director Huang were in the room, and they felt a little uncomfortable for a while—it was too quiet here.

In the room, several hospital workers wearing P4 protective suits are continuing the installation of breathing wiring, while other medical staff are waiting outside the clean room, ready to wait until Sun Lien or Director Huang are unwell and can no longer continue to persevere.

Dr. Yuan Ping'an and Dr. Cao Yanhua each brought two nurses to wait, while Dr. Brunn and Dr. Pascal also decided to prepare for the waiting together.

"You wait inside for two hours and then come out for a shift. Yuan Ping'an said unceremoniously to his team leader, "Wear a mask for more than an hour, if the patient needs chest compressions, then you quickly step back, and we will go in and do compressions - Nicole, don't take off your mask inside, this is the plague!"

"Got it, got it. Sun Lien agreed weakly, Yuan Ping'an met him for the first time in the Fourth Courtyard, and met Dean Song and scolded him for picking his own skin. In this month, I probably heard a lot about my original "heroic feats", which is why I am so nervous.

"You were the one who took off the mask in the clean room last time to save the patient?" Director Huang was really shocked at this time, but he didn't expect this Dr. Sun to be a ruthless person.

Sun Lien coughed embarrassedly, and was about to say something when he suddenly heard a sharp alarm.

The monitor beside Tang Xingde screamed, this movement Sun Lien is already very familiar with - ventricular fibrillation waveform!

"Push the defibrillator, prepare two lidocaine intravenous boluses, hurry!" Sun Lien hurriedly pounced on Tang Xingde's side and began chest compressions. Wearing an N95 mask, chest compressions are very laborious, but he has only been wearing it for a long time, and his physical strength can still hold it at present.

Sun Lien glanced at the status bar on Tang Xingde's head, and sure enough, a new status was added - ventricular fibrillation (8/8 times before defibrillation was successfully lifted).

It took eight defibrillations to subside, but at least it means that people can be saved. Sun Lien's heart relaxed a little, and while doing chest compressions with all his might, he quickly pondered in his mind why Tang Xingde suddenly had ventricular fibrillation.

In addition to electrical defibrillation, correcting the cause of ventricular fibrillation is also one of the important means to relieve ventricular fibrillation.

There are now five known status columns: "Greatly elevated white blood cell levels", "High fever", "Severe pneumonia", "Sinus tachyrhythmia", and "Decreased fibrinogen concentration". Greatly elevated levels of white blood cells mean that the patient is in a serious bacterial infection. A bacterial infection can cause bacterial emboli in the blood and block the coronary arteries, resulting in ventricular fibrillation.

High fever? This is one of the evidences that the body is fighting off bacteria, and in order to control the collateral physical damage caused by high fever, doctors in the four hospitals have used ice blankets to cool down the three people. None of them inhaled depolarizing muscle relaxants, and this hyperthermia was naturally not caused by malignant hyperthermia. On the flip side, a high core temperature may indeed lead to a large number of cell deaths, resulting in the release of too much potassium. When this potassium enters the bloodstream, it can cause high levels of potassium in the blood, which can quickly lead to ventricular fibrillation and death.

Needless to say, severe pneumonia can be seen in combination with sinus tachyrhythmia. Pneumonia causes the body to have insufficient oxygen levels. And all three of them have frighteningly high heart rates. The heart does not get enough oxygen under intense load, and as a result, lactic acid accumulates, which leads to ventricular fibrillation.

The decrease in fibrinogen concentration directly reduces the possibility of DIC. If a patient has a sudden DIC, there is a real possibility that the coronary arteries will be blocked by a blood clot and cause ventricular fibrillation.

Five states, four completely different causes of ventricular fibrillation. Each has a high probability, and the treatment for each is different. Sun had to immediately find out what really caused the patient's ventricular fibrillation and treat it. Otherwise, even if Tang Xingde recovers sinus rhythm after eight electrical defibrillations, he may have to tremble again in a few minutes.

The first ventricular fibrillation requires eight defibrillations, and as a general rule of thumb, the number of subsequent defibrillations will increase and the defibrillation will become more and more difficult. Sun Lien even felt that if Tang Xingde trembled again after this defibrillation was successful, it was likely that he would not be able to save it.

Think quickly, think quickly! Sun Lien pressed Tang Xingde's chest hard, and shouted at Yuan Ping'an, who rushed into the clean room, "Come and help!"

Yuan Ping'an rushed in with nurses Xiao Guo and Zhong Yu at the moment when the monitor alarmed, Yuan Ping'an waited one step next to Sun Lien, ready to take over chest compressions at any time, and Xiao Guo rushed to the ambulance five meters away in three steps, dragged the defibrillator and rushed back to start charging, while Zhong Yu pulled out the drawer under the ambulance, took out lidocaine from it and began to perform intravenous bolus.

Sun Lien dodged the space, but Yuan Ping'an took over the chest compressions, and he quickly took two steps back, and after confirming that there was no other status bar on Tang Xingde's head, he began to think quickly about countermeasures.

Yersinia pestis is extremely unlikely to cause bacterial embolism, and when bacteria invade human tissues, the necrotic tissue and bacteria are mixed and float in the bloodstream, forming bacterial embolism. However, the time for Tang Xingde and his family to be infected with the plague was too short to produce bacterial embolism.

Hyperkalemia is possible, but the three patients are still in a state of extreme heat for a short time, and although there are indicators of acute kidney injury, the human organs have the ability to compensate. Based on Tang Xingde's current kidney function indicators and the state of his body edema, his kidneys are far from failing. The likelihood of high potassium in the blood is not too high.

DIC? That's easy to rule out. Sun Lien glanced at the intravenous infusion needle on Tang Xingde's arm, and there was no trace of blood leaking outward. This can also be ruled out.

"Acidosis is the most likely, Nurse Zhong, ten milliliters of 5% sodium bicarbonate, intravenous bolus!" Sun Lien locked the most suspicious reason, not that high blood potassium is completely impossible, in comparison, 5% sodium bicarbonate is the fastest infusion, and even if the judgment is wrong, it will not cause direct danger to the patient - not to mention that sodium bicarbonate itself also has a therapeutic effect on patients with high blood potassium.

"The fourth defibrillation, 220J, dodge!" Xiao Guo completed the third defibrillation, but the effect was still not ideal. Yuan Ping'an continued to do chest compressions, but there was already a layer of fine sweat on his head, and it seemed that he would probably not last long.

"I'll take over, and you're going to let Dr. Cao in. Sun Lien stood beside Yuan Ping'an, "Change hands with me after the fifth defibrillation!"

High-quality chest compressions are an important factor in improving the success rate of defibrillation. By high quality, it means that the doctor's chest compressions must be of sufficient force and frequency. The physical exertion is staggering, so it is necessary to make timely substitutions in the middle of chest compressions.

"I'll do it. Brune walked in with a mask and protective gear, his beard looking a little ridiculous under the N95 mask. "You young doctors don't have enough physical strength to usually eat meat?"

For the first time in his life, Yuan Ping'an felt that the red-necked motorcycle riders in the United States were really cool.