Munten's condition is very poor, and even if he is placed in the fourth hospital, he is the kind of patient who will be immediately sent to the ICU for follow-up treatment. But for the medical team, the situation is a bit tricky.

As part of the medical project to support Polytavia, the medical team also carried a batch of relatively "advanced" medical equipment. It includes three cardiopulmonary monitors, ventilators, dialysis machines and other equipment. But this is not the main aid equipment – it is more of a "teaching aid" that will be used by the medical team to demonstrate the use of the local doctors and allow them to accumulate enough experience and skills.

Because of this, the number of life monitoring and support equipment carried by the medical team is very limited. Originally, 20 doctors had to be filled in the intensive care department according to the setting of a tertiary hospital, which was not enough. So everyone didn't think there was anything wrong with it at first.

It wasn't until Sun Lien came...... Suddenly, things were different.

The intensive care department, which was supposed to be relatively well-stocked, was suddenly understaffed. Originally, the medical team still had two dialysis machines and a cardiopulmonary monitor to use, but after the old wizard who was seriously injured in a car accident was admitted for treatment, the cardiopulmonary monitor was occupied, and there was only one dialysis machine left, and the ventilator was also gone - the medical team originally only had two ventilators, a special anesthesia ventilator was placed in the operating room for the operation, and the other was allocated to the little girl who underwent a liver transplant. The old wizard also needed ventilator support, and the one he used had just been brought out of the operating room.

Munten's condition is not very good, Liu Tangchun knows very well that if he really has hypoglycemic encephalopathy combined with rhabdomyolysis, then the treatment process in intensive care will take at least ten days - hypoglycemic encephalopathy is not very important, just replenish glucose in time. The real trouble is rhabdomyolysis.

Rhabdomyolysis can cause several injuries to the patient himself. First of all, the most serious is the potassium released by a large number of dead muscle cells. If the potassium concentration in the blood is too high, it will directly suppress the patient's heart muscle, resulting in a decrease in the patient's heart muscle tone. If this condition continues, there is a high risk of arrhythmia or even direct cardiac arrest.

Concentrations of potassium in the blood also release acetylcholine, which affects the vagus nerve in the patient—and may even cause symptoms similar to organophosphate poisoning. Hyperkalemia can also affect the patient's central nervous system, causing confusion or irritability.

In addition to high potassium in the blood, rhabdomyolysis also causes a large amount of myoglobin to be released into the bloodstream. These proteins can hinder the work of the glomeruli, causing acute liver and kidney damage. Judging from the current situation, this kind of acute liver and kidney injury will inevitably lead to acute liver and kidney failure if it cannot be immediately intervened and treated symptomatically.

At present, in this village, there is very little that the medical team can do other than inject 10% calcium gluconate to combat the effects of high blood potassium on the heart. Whether it is to inhibit the excessive secretion of acetylcholine, correct metabolic acidosis caused by high blood potassium, or remove myoglobin from the patient's blood to protect the liver and kidneys, these means are not provided by the medical team on patrol.

Whether a patient can tolerate the transfer on the road is not the first thing to consider from the current point of view - if Munten had been left here for a maximum of 48 hours, he would have died of arrhythmias or acute kidney failure due to high potassium in his blood. Now, for Liu Tangchun, the most priority should be whether the remaining medical resources can handle the critically ill patients who may be sent at any time after the patient is admitted.

To put it mildly, if this concern is in China, it can be left to the patient's family to decide. After all, the cost of ICU treatment is extremely high, and even if the patient is transferred to the hospital in time, there may be irreparable kidney failure or even liver failure. The difficulty and cost of follow-up treatment are so high that a large number of the families of poor patients can choose to give up.

But this is not in China, and Liu Tangchun represents not only the emergency department of the Fourth Central Hospital of Ningyuan City, Song'an Province. The medical teams sent abroad represent China and the country. How heavy this weight is, Liu Tangchun knows it very well in his heart.

"We don't have enough medical equipment right now, and he's in a serious situation. Liu Tangchun pondered for a moment and then made a decision, "It's not a big problem for the medical team to use the current medical equipment for him first, but we also have to consider the patients who will be sent to the station later." ”

Sun Lien was a little heavy as he listened, and he also knew the family background of the medical team. If Munten were to be admitted, it would take at least three valuable life-support and monitoring equipment, as well as the energy and time of one bed and at least two doctors. It's not that the medical team can't move these medical resources, but if these resources and time are used on other patients, there is no telling how many people can be saved.

Even if Liu Tangchun decides to give up on this young man, everyone will not have any complaints—at most, they will just blame themselves for why their ability is not enough.

"We start by moving the patients to the residency. At least save his life first. Liu Tangchun continued, "Then immediately contact the Daishan Island and ask them to send a helicopter to transfer the patient and let him receive follow-up treatment on the Peace Ark." ”

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Liu Tangchun's words saved a broken family and a woman's future life, but it also brought a lot of trouble to the medical team, the Daishan Island, and the Polythanvian government and military.

At the request of the Polytavian government, the Daishan Island hospital ship was dispatched by the Chinese side to carry out a humanitarian rescue mission. As the world's first large-scale purpose-built hospital ship, the vessel is very well equipped. It is even more advanced and professional than some ordinary tertiary hospitals.

However, the helicopters equipped with advanced and professional hospital ships are still the Z-8 basic helicopters that began to be developed in the mid-seventies of the last century. As a 13-ton utility helicopter, the Z-8 on the Daishan Island has a range of about 800 kilometers.

However, the Daishan Island is currently located at the mouth of the Rufuma River, about 470 kilometers in a straight line from the camp of the Seventh Bureau. The helicopter itself does not have enough fuel to support it for a round trip. If you want to carry out this patient transfer mission, you will either have to refuel at the camp of the Seventh Bureau, or you will have to choose an airport to land at one of the airports during the flight to refuel.

And that's just a minor annoyance in operation.

Although the Daishan Island is a hospital ship, it still belongs to the naval sequence. Her helicopters, naturally, also belong to the category of military aircraft. Foreign military aircraft flying into a sovereign state to carry out a humanitarian rescue mission in that country's airspace requires a very complicated and cumbersome approval – and the approval process can only begin after the Polythanvian side has made an initiative to request for help and has been accepted by us. All in all, a lot of trouble.

But compared to a life, these troubles are just troubles.

Liu Tangchun's attitude was very resolute, and the patient must be sent to Daishan Island for follow-up treatment as soon as possible. The Daishan Island has also made it clear that it is willing to accept patients – as long as the Polish side is willing to provide corresponding assistance.

As soon as the vehicle carrying Manten arrived at the camp of the Seventh Bureau, Liu Tangchun took his interpreter and students into another car and left for the dust—their destination was Port Melati. On the way here, Director Liu had already informed the Polythanvian authorities of the patient's situation and asked for assistance, but after almost two years in Africa, he knew how slow and ineffective the local administration was. So he decided to take someone to watch every process and step in person.

In any case, the medical team is very popular in Polytavia and is very popular among the local residents. Using his own face to exchange the hope of a patient's life, Comrade Liu felt that he did not lose at all.

In the camp, Sun Lien and Hu Jia are organizing further rescue and treatment for Mangteng. His arterial blood gas test came out just a few minutes ago and the results were very bad.

Munten's blood pH was 7.28, the partial pressure of carbon dioxide was 27.7 mmHg, the partial pressure of oxygen was 88.6 mmHg, the concentration of potassium was 5.53 mmol/L, the concentration of sodium was 144 mmol/L, the remaining base was -11.9 mmol/L, and the blood lactate was 8.4 mmol/L. The results of the blood routine were not very optimistic, with white blood cell count of 17.81×10^9/L, neutrophil 7.88×10^9/L, red blood cell count of 3.71×10^12/L, and hemoglobin 121g/L.

What is even more worrying is his serum myoglobin and creatine kinase indicators. Among them, serum myoglobin is greater than 12000ng/ml, and creatine kinase is as high as 3814U/L.

In addition to directing the patient's oxygen inhalation, large fluid rehydration, and maintaining water electrolytic balance, Sun Lien also used the alkalizing urine technique he learned from Xu Yourong before, as well as hepatoprotective therapy. On the other hand, he was also urging the laboratory to complete the urine routine as soon as possible - before administering kidney replacement therapy to the patient, he must at least find out how badly Munten's kidneys were damaged.