Li Songzhao is indeed sick. Needless to say, the two big men directly flipped Li Songzhao over and laid him flat on the ground, monitored Li Songzhao's heart rate with a portable cardiopulmonary monitor, and did an electrocardiogram monitoring by the way. Unsurprisingly, the T wave is sharply symmetrically inverted, suggesting acute right ventricular dilation, typical of pulmonary embolic ECG changes.

Dahan A ran out of the Internet café to drag the emergency bed, while Sun Lien asked for two pairs of latex gloves on Dahan B. After making sure that the gloves had been worn and were not damaged, Sun Lien carefully took off the shoes on Li Songzhao's feet. A strong fishy smell came to his nose, and the socks on his feet, which were supposed to be white, were wet, and the edges of his toes showed strange traces of blue and yellow liquid soaking. Removing the two socks that he didn't know how long he had been wearing, Li Songzhao's feet were directly exposed to the air.

Starting from the thumb of Li Songzhao's right foot, there was a hole about five centimeters by three centimeters. The sores were still slowly flowing out of the swelling of pus.

Dahan B glanced at Li Songzhao's feet and said strangely, "It really looks like a diabetic foot, how can you tell it? It can't be that you are lying at his feet and smelling it, right?"

"It's such a big smell, as long as you have a nose, you can definitely smell it. Sun Lien took off his latex gloves, took two steps back, looked at Li Songzhao's feet and shook his head and sighed, "This level of diabetic foot...... I have to do an amputation. ”

Lee's foot injury is severe, but it's not a top priority right now. Dahan A rushed in with an emergency bed, and there was still a bottle of oxygen tube on the bed. The two big men worked together to transfer Li Songzhao to the bed, and skillfully buckled the oxygen mask on his face. The oxygen flux was prescribed to the maximum, and then Dahan B took out a bottle of sodium heparin from the medicine box, dissolved it with the sodium chloride injection in the vial, and prepared to pierce the vein in the middle of Li Songzhao's elbow.

After cutting his clothes with scissors, Dahan B was dumbfounded, "This ......" He looked at the gray skin on Li Songzhao's arm, "What's wrong with this?"

Sun Lien glanced at it and instructed, "It's just been a long time since I took a bath." Wipe that alcohol cotton ball. He picked up the bottle of mineral water that he hadn't had time to open and handed it over, "Wash the dirt first, and then wipe it with a cotton ball." ”

The alcohol cotton balls distributed by the pre-hospital emergency responders should actually be called alcohol wipes. The advantage is that each tablet is individually packaged, which is easy to use and carry. But that's where the inconvenience comes in – if you need to wipe with a lot of alcohol cotton balls, you won't be able to use a non-woven fabric soaked in alcohol at all. Sun Lien also saw the wipes taken out by the big men, so he turned to let them take a bath on the spot to remove the dirt.

Disinfection in this emergency situation is not because doctors have any hygiene habits. It's purely because Li Songzhao's body is too dirty. It was so dirty that Sun Lien was worried that the needle would be blocked. Compared to the hands, the elbows do not usually come into contact with other things, and the dirt is not "pulped". Instead, the pieces naturally fall off, and then the moisture expelled by the body's heat and pores sticks to the body. Dahan B rubbed a piece of gauze and a whole bottle of mineral water from Sun Lien for several minutes, and then he could barely rub out a piece of real skin. Then he disinfected it with an alcohol wipe, and then injected a piece of heparin sodium into Li Songzhao's vein.

"Get in the car and send it nearby. The two big men pushed the first aid wound into the car, and by the way, Sun Lien was also dragged up. "You reported 120, and you're a doctor. At least come with us and get a handover with the doctors in the emergency department of the hospital. ”

Sun Lien was dragged into the car like this. It's a pity that he spent 30 yuan to open a night computer, which only took less than an hour. And the owner of the Internet café looked at Li Songzhao's pair of socks with an angry expression, and it seemed that he would not return the money to Sun Lien.

After ......getting into the ambulance, Dahan A patted the driver's platform and said to the driver, "Brother Wang, send Xiehe." ”

"Concord, huh?" the driver didn't look very old, but for some reason he was called "brother" by the pre-hospital emergency who looked almost forty, but his reaction was still very decisive. "No problem!"

With a two-foot throttle, the driver jerked up the clutch and randomly kicked the floor oil down. The heavy ambulance even had a slight tendency to look up, followed by a screeching sound of tires scraping against the ground.

Although the ambulance accelerated quickly, there was no violent shaking in the cabin. Although it is late at night, there are still many cars on the streets of Beijing. Passing left and right in the traffic, but in three minutes, the howling ambulance drove down Dongdan North Street and entered the entrance of the emergency hall of Union Hospital.

"Just predicted, acute pulmonary embolism, complicated by diabetic foot. While jumping out of the ambulance at the same speed as flying, Dahan A shouted to the doctors and nurses who hurried out of the emergency hall, "I have been on high-concentration oxygen and injected 7,000 units of heparin sodium intravenously." ”

Sun Lien also jumped out of the car and helped push the bed towards the emergency room. Dahan A pointed at Sun Lien, "This is the doctor who called the ambulance, and he can see that there is something wrong with this person." When we arrived, the patient suddenly stood up and was very emotional. Then he suddenly collapsed clutching his chest. ”

The doctor who received the doctor glanced at Sun Lien in surprise, "Whose student are you? ”

"Forehead......" Sun Lien was stunned for a moment, and then he realized that the other party probably regarded himself as a doctor of Xiehe. "I came to Beijing from Ningyuan on a business trip. ”

"From the Fourth Central Hospital?" the other party immediately called out Sun Lien's unit, "I heard Director Zhu mention your hospital, the big emergency center, right?"

While they were talking, the nurses next to them had quickly guided the emergency bed to an empty bed. Several people worked together to lift Li Songzhao to the bed. Then he began to stick electrodes on him.

However, the pasting of electrode patches encountered unprecedented difficulties at this time. The patches either don't stick at all, or they don't respond at all. This made the nurses of Concord anxious. Seeing that this person was dirty like this, the nurses could only hold a bottle of 500 ml of normal saline and began to wipe the thick layer of dirt on Li Songzhao's body with gauze. Black water flowed down his body, and the sour smell filled almost the entire emergency room. It took a while for the nurses to finally rub out a few areas of his body that needed to be clean. Only then did the electrode patch be reluctantly attached.

While the nurses were scrubbing Li Songzhao, the doctor who accosted Sun Lien operated a B-ultrasound and had determined that there was indeed a thrombus in the deep veins of Li Songzhao's lower limbs. However, the exact size needs to be confirmed by imaging tests. Considering that Li Songzhao had been injected with anticoagulant heparin in the pre-hospital emergency care, the first priority now should be to solve his lung embolism.

Li Songzhao's pulmonary embolism symptoms are very typical, and there is no difficulty in diagnosis. dyspnea, syncope, tachypnea, wheezing, tachycardia, jugular venous distension. These are very typical symptoms of acute pulmonary embolism. However, the exact size of the embolism can only be known after pulmonary angiography is done on CT.

The doctor who talked to Sun Lien introduced himself, "My name is Yuan Ping'an, and I am the general resident here, do you know Professor Liu Pingchuan?"

Sun Lien stretched out his hand and shook it, "My name is Sun Lien." Professor Liu is currently the Associate Dean of our School. ”

"You are Sun Lien?" Yuan Ping'an grinned, "I saw a post about you in the Lingering Fragrance Garden." He paused and asked curiously, "Is Professor Liu's student really on the same treatment team as you?"

Sun Lien nodded helplessly, "Although there are many unavoidable places in the middle, the truth is that this is true. ”

Yuan Ping'an and Sun Lien's handshake was a little stronger, "I have also listened to Professor Liu's class before, and I originally wanted to take Professor Liu's research group when I was taking the doctoral exam, but I didn't expect that Professor Liu was poached by your Fourth Central Hospital." ”

Sun Lien suddenly felt a little cold behind him.

"I studied neurosurgery as a graduate student, and I originally thought that the research direction of my graduate school would coincide with Professor Liu's direction......" Yuan Ping'an shook hands with greater strength, "I didn't expect that two days before my interview, Professor Liu was actually poached by you." He gritted his teeth and looked at Sun Lien with very "kind" eyes, "In the end, I was reluctantly accepted by Professor Zhu in the direction of emergency medicine." ”

can be admitted to the doctorate of Xiehe, Yuan Ping'an's own level will definitely not be bad. But a former neurosurgeon turned into an emergency hospitalist, and the story that happened in the middle is only afraid that there will be a lot of blood and tears in addition to the waves. Sun Lien looked at the doctor who shook hands with some sympathy, but he didn't know what to say to comfort him.

The emergency department can dominate the operation of the entire hospital, which can only happen in a hospital in the big emergency mode. As the apex of Chinese medicine, although the emergency department of Xiehe is also very powerful, it is not as valuable as their neurosurgery and cardiac surgery. Yuan Ping'an, who originally came for Dr. Shenwai of Peking Union Medical College, became a doctor of emergency medicine at Peking Union Medical College, and the psychological gap in the middle can be imagined.

"Doctor Yuan!" The nurse sister next to her relieved Sun Lien in time, "The patient's blood oxygen saturation is decreasing!"

The cardiopulmonary monitor next to Li Songzhao was screaming, his blood oxygen saturation had been less than 90%, and in the ten or so minutes that Yuan Ping'an shook hands with Sun Lien and did basic examinations, Li Songzhao's blood oxygen saturation had dropped to 87%, and it was still gradually declining.

"Is the oxygen concentration the highest?" Yuan Ping'an let go of Sun Lien's hand and turned to see the situation. He watched the cardiopulmonary monitor as he adjusted his support regimen. "How much heparin sodium was given before the hospital?"

"Seven thousand units. Sun Lien replied in a timely manner, "There is no other drug treatment except heparin sodium." ”

"Two thousand more units. Yuan Ping'an frowned, "What is his blood clotting time now?"

"Prothrombin time (PT) 17 seconds. "The nurse has already got the test results," the INR estimate is 1.6, which is not enough time. ”

"It shouldn't be. Yuan Ping'an's brows furrowed even deeper, "Please ask the hematology department to come for consultation, this patient may be insensitive to heparin." ”