Sun Lien unknowingly completed a "transaction" about the paper, and from the perspective of behavior alone, he seems to have a little bit of the meaning of "learning valve" - with his three or two sentences, he can decide who will send a paper. Of course, in essence, Sun Lien is still far, far from that situation.

Before going to work the next day, Sun Lien was still thinking about his academic qualifications in the dormitory. As a doctor, joining the job after graduating from a bachelor's degree is basically declaring that you can only work in a grassroots hospital or rural health center for the rest of your life. For today's young doctors, as long as they want to make a difference in their careers, a master's degree is considered the minimum requirement.

Sun Lien is more pragmatic, he just graduated from the undergraduate degree and chose to take the four colleges of regular training - he is a little unconfident in his ability to take the exam. Moreover, during the one-year internship in his fifth year, he did not have enough energy to revise for the graduate exam.

Sun Lien's original plan was to study clinical knowledge seriously during the three years of regular training, and find the most suitable mentor for him in the department rotation. But Sun Lien missed one point - it is true that the Fourth Hospital is a training base, but it is also a pilot unit for major emergency training. As a pilot unit, the training plan of the four institutes is different. Regardless of whether you are an internal medicine or surgeon, as long as you come to the four hospitals, you have to go to the emergency department for exercise. And it's not as simple as one round of training - each trainee has to enter the emergency department twice in the three-year rotation career for a total of six months, one emergency rescue, and one emergency clinic.

After Sun Lien entered the list of internal medicine training of the four hospitals as the first place in internal medicine, he understood why most of the young doctors who came to the examination for the training of the four hospitals were relatively ...... Crooked melon cracked dates. A total of half a year of emergency planning and training career is enough to persuade many medical students who are afraid of hardship and tiredness.

And after three months of regular training, Sun Lien woke up and received the blessing of the ability of the status bar. However, it was not because of this that he strengthened his determination to continue to do clinical work in the emergency department - Sun Lien was able to insist on doing emergency clinical practice, or because he won Liu Tangchun's favor.

Thinking about this, Sun Lien finally understood what Cao Yanhua meant by "having resources". How many trainees in the world can be remembered by the director of the emergency department in the third month of regular training? and can also become the deputy head of the diagnosis team in the first year of obtaining the medical certificate...... This kind of thing is probably only available on the Internet in the whole world.

The fame of the Fourth Hospital and Sun Lien in diagnosis has gradually begun to expand to other provinces. Takeda Pharmaceutical is also making continuous efforts to promote the Zhou Xiufang Comprehensive Diagnostic Center as an important development direction in the future. From this point of view, Sun Lien's resources are really not comparable to ordinary deputy high schools or even directors.

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"Lien, you come to my office at noon today. After thinking about it calmly, Sun Lien, who found that he already had a very powerful background, received a call from Liu Tangchun in the office. Liu Tangchun on the other end of the phone didn't say much, he just instructed Sun Lien in a very normal tone, "Let's have a meal together at noon." ”

I don't know if I'm going to eat Vice President Liu's special claypot rice. Sun Lien muttered a little in his heart about this, but he quickly promised that he would arrive at Liu Tangchun's office on time.

No, no, no...... Yesterday, Brother Cao just talked to him about studying for a doctorate, and this time Mr. Liu really wanted to ask him to go to the office? Sun Lien felt an itch in his heart, if Liu Tangchun really wanted him to study for a doctorate, then Sun Lien was naturally 10,000 willing. A Ph.D. will be of great benefit to his future career, and Sun is well aware of this.

But that's for later, at least after noon. Sun Lien drank two glasses of ice water in a row to suppress his restless heart. The first priority now is to take good care of people.

This morning, Sun Lien still has half of the emergency clinic to see, and the time to see it is now the time period when the outpatient clinic has not yet started and the ICU has started ward rounds. Sun Lien decided to go to the ICU first to see what happened to the unlucky ghost who fell from the roof of Sun City.

As soon as he changed his clothes and entered the ICU, Sun Lien suddenly heard a chaotic movement. At the side of a hospital bed, there were seven or eight stern-faced doctors. Sun Lien's heart suddenly "chuckled" - this situation is not good, and this hospital bed ...... Isn't this the bed that Zhang Junyi is closest to the doctor's office and the nurse's station?

A little closer, Sun Lien confirmed through the status bar that it was indeed Zhang Junyi who was lying on the bed and dying. The status bar also explained to Sun Lien what was happening earlier than other ICU doctors.

There are three states on the top of Zhang Junyi's head that are particularly noticeable, one is "acute gastrointestinal injury" that has occurred for about a day and "sepsis" for a short time, and the latest state is "disseminated intravascular coagulation", the direct cause of which doctors are so nervous.

Acute gastrointestinal injury? Abbreviated AGI. Is it a severe symptom that occurs more often after a critical illness? It is a component of multiple organ dysfunction syndrome (MODS). It can also be a serious consequence of diseases of the gastrointestinal mucosa and the digestive system itself. All in all, acute gastrointestinal injury is probably one of the most serious digestive disorders that can occur in a person.

Is the inside of the intestine an organ with a very good blood supply? At the same time, the villi and mucosa of the small intestine are very poorly tolerated to severe infections and tissue ischemia and hypoxia. As one of the earliest and most severely affected organs? When the patient is critically ill, due to factors including inadequate blood supply, inflammatory response, and vascular function involvement? The patient's intestine may experience extensive intestinal mucosal damage or even necrosis. And after this part of the tissue is damaged, the most direct consequence is to lead to the displacement of the intestinal flora? This leads to enterogenic infections and enterogenic sepsis.

The alcohol-rich contents of Zhang's digestive tract undoubtedly exacerbated the extent of this damage. And after most of the liver has been removed? His body's ability to process various waste products has been drastically reduced, which also increases the load on other organs of the body.

If you look at it from the perspective of time alone, Zhang Junyi's acute gastrointestinal injury should be the existence of aggravated symptoms, but you have to think about it carefully? Sun Lien thinks? Liver damage is probably just a trigger in the MODS that is the cause, and what really causes the mods to be initiated...... I'm afraid it's really an acute gastrointestinal injury at the beginning.

Acute gastrointestinal injury often occurs instantaneously, due to the body's self-protection mechanism, Zhang Junyi's body actively constricts the blood vessels of most organs after heavy bleeding? Attempts to maintain blood supply to certain critical nodes and organs as much as possible. And at the moment when the body makes this self-protection mechanism, the occurrence of acute gastrointestinal injury has already been determined.

Isn't it true that the doctors of the Fourth Hospital were unaware of the occurrence of acute gastrointestinal injury? They had the foresight to decide to be cautious about using opioid analgesics. But this decision alone is not enough to prevent further deterioration of AGI. In fact, Zhang Junyi's AGI classification in the Department of Critical Care Medicine is only Level 3. And when MODS happen? Patients identified as having AGI should be immediately reclassified as the most severe, grade 4, and emergency surgery should be initiated as soon as possible.

But...... What is the versus surgery for acute gastrointestinal injury? Now Zhang Junyi's situation is even more critical.

After an acute gastrointestinal injury? Zhang Junyi's intestinal tract has a displacement of microflora. Large numbers of Escherichia coli, Proteus and Klebsiella pneumoniae move from the rectum and colon to the small intestine. A large number of bacteria grow and multiply quickly? and enter the blood vessels through the mucous membranes that have been broken. The infection began to spread in Zhang Junyi's body, causing severe sepsis.

The endotoxin of sepsis and the tumor necrosis factor TNF released by sepsis damage to the body work together in blood vessels, inducing macrophages and endothelial cells to start releasing tissue factors. This action activates the exogenous coagulation pathway. Coagulation factor XII, which is activated by endotoxin, also activates the endogenous coagulation pathway. The combined action of these two pathways ultimately triggers the occurrence of diffuse intravascular coagulation.

What's worse is that because a large part of his liver was removed, Zhang Junyi's body could not produce enough blood clotting substances at all. As a result, DIC has almost just appeared, and it has already entered the stage of terminal stage.

The speed at which sepsis developed in his body was simply too fast. Although the doctors in the ICU have monitored Zhang Junyi closely enough, it is far from enough in the face of this rate of deterioration. They are still paying more attention to the damage to other organs in Zhang Junyi's body and the symptoms of the central nervous system. They did not detect the signs and intervene at a sufficiently early stage. Right now...... Zhang Junyi's DIC has almost entered the terminal stage.

A large amount of low-molecular-weight heparin sodium was injected into Zhang Junyi's body through an intravenous channel, but his body had become a water-filled balloon that had been roughly stitched together. Blood began to flow out of the sutures on his body, and the pressurized infusion of blood products had reached an alarming level - eight nurses were squeezing the blood bag in their hands with all their might, but the monitor on Zhang Junyi's body was still alarming - his heart rate had risen to 165 beats, and his blood pressure was only 90/45mmHg.

Zhang Junyi's body has too many external injuries, and the biochemical magicians in the intensive care medicine department have exhausted all their means. But...... They still couldn't stop Zhang Junyi from being pulled into the ghost gate again.

Twenty-four minutes after Sun Lien entered the ICU, the doctors stopped their efforts to resuscitate him.

"At 7:27 a.m., he was pronounced dead. The doctor on duty in the ICU looked at the wall clock in the ward, raised his gloved, but already sore and shivering hands, stained with dark red blood, and sighed.