Sun Lien hadn't seen the status bar warning for a month.

At around four o'clock this afternoon, the emergency department of the Fourth Central Hospital of Ningyuan City received a family of three who came to see a doctor. All three presented with a high fever, accompanied by a severe headache, aching limbs, and coughing up large amounts of bright red bloody sputum.

The medical staff of the emergency center of the fourth hospital, who had just received the avian flu treatment a month ago, did not even hesitate at all, and directly called the doctors from the hospital's infectious diseases and infectious diseases department to come for consultation. And quickly began to transfer the patients in the emergency room - if they were really in a bad state and could not be transferred, they would be pushed to the emergency room with the bed and the family of three would not be able to pass through.

Although it is uncertain what it is, a family of three developed at the same time, and the high fever showed obvious upper respiratory symptoms. Before the province's secondary response mechanism was lifted, doctors at the four hospitals immediately treated the three as highly suspicious patients with infectious diseases. It is better to have a false alarm afterwards than to carelessly lead to continued infection. What's more, looking at the course of these three people's illnesses, a very terrifying term came to the minds of the doctors.

Plague.

Yuan Ping'an was patrolling the emergency room at first, and when he saw the three patients coming in, he immediately stopped the nurse who was pushing the bed and was about to leave, and announced that the emergency room was closed. The evacuation of the relatively stable patient was completed with the assistance of other physicians. Subsequently, he called Sun Lien.

"Their situation is too much like the plague. Yuan Ping'an said to Sun Lien, "Director Zhou, I just called, and he also agreed with my move to close the emergency department." ”

Yuan Ping'an did not actually have the right to announce the closure of the rescue room, and he had to immediately notify Zhou Jun, who had the relevant rights, and obtain permission. At the same time, he also had to inform his senior doctor, judging from the current treatment group structure, he had to notify Sun Lien immediately.

Sun Lien smiled bitterly twice, and the eyes full of "warning, high transmission risk" and "warning, high fatal risk" were like small advertisements pasted on the street poles, unscrupulously pasted everywhere. Compared with the previous "high risk of transmission" of avian flu, there is an additional "high fatal risk", and the status bar almost clearly states that these three patients have serious infectious diseases. And the risk is much higher than avian flu.

"How's the patient?" "Although the disinfection and disposal are left to the hospital and infectious diseases. But the emergency department still has to do its own work. Rescuing patients and maintaining vital signs should not be delayed because of the fear of infectious diseases.

"Sinus tachycardia, my son's heart rate is 148, both parents are at 151, and the blood pressure is a little low. Yuan Ping'an was reminded by Sun Lien, and only then did he realize that he had not done a basic physical examination for the patient. Fortunately, the nurses and sisters next to them are powerful enough to put monitors on all three of them.

"Draw blood, go and culture. After all, Sun Lien has been the leader of Yuan Ping'an for more than a month, and he is familiar with the rescue process when he directs it. "Each patient takes a sample and sends it directly to the CDC. ”

After arranging this series of work, Sun Lien can finally take a look at the status bar of the three patients.

"Tang Xingde, male, 48 years old", "Hou Huiying, female, 45 years old", "Tang Wen, male, 22 years old".

For a family of three, five states are neatly marked on the status bar, and the difference in the earliest state on the heads of the three is no more than 14 minutes, and the earliest symptom time is only 29 hours. It is almost certain that they were infected by a single source of infection at the same time.

The five states are "substantially elevated white blood cell levels", "high fever", "severe pneumonia", "sinus tachyrhythmia", and "decreased fibrinogen concentration".

Dramatically elevated levels of white blood cells, high fever, and severe pneumonia are all important signs of bacterial infection. Sinus tachyrhythmia may be caused by acute myocarditis or infection or fever. And fibrinogen concentrations are reduced, needless to say, this is an old friend. Excessive reduction may lead to the development of DIC in the patient's body, and eventually death due to hemolysis and thrombosis.

"What is your body temperature?" Sun Lien put on protective goggles and gloves, and changed into a coverall, which is the defense standard for emergency patients with fever under the second-level emergency response mechanism As for the mask, the N95 mask without a breathing valve is now basically standard in the fourth hospital.

“41℃。 Yuan Ping'an also changed into the same protective clothing, and took the ice blanket handed by the nurses and sisters on the side, covered the three of them, and asked the nurses, "What about the other family members?

"No, the family lives alone. Just returned from a trip out of town. The neighbor asked them to eat together at noon today, but they didn't wait for anyone to come. Finally, "when I knocked on the door, I found that they were not in the right state, so I helped call 120." ”

"Call the police, contact the CDC, and tell them to quarantine that neighbor immediately. Also, figuring out where exactly they are traveling. In particular, it is important to find out whether they have been to the natural plague area. Yuan Ping'an is still worried that the plague may continue to spread. Song An province is not a natural plague epidemic area, and this family of three is likely to have been infected elsewhere. If there are other pneumonic plague patients who are infected and spread to this family, it means that there is another source of plague transmission that is wandering uncontrollably outside the hospital.

"Where have you been playing before?Have you ever been in contact with marmots, gerbils, or other rodents?" Sun Lien's move was more direct, he patted Tang Wen on the shoulder and asked, Tang Wen's parents looked a little indifferent, the blood oxygen saturation of the two was rapidly decreasing, and the other doctors were intubating and rescuing. Now is not the time to worry about the spread of infectious diseases, at least it is not Sun Lien's turn to worry about this.

"We went to Saihai Province...... The reception over there invited us to eat roasted marmots......" Tang Wen tried to answer the doctor's question. He was younger, but he knew more about it than his parents, "and we also saw marmot skins......

"When did you eat?" Sun Lien was taken aback and hurriedly asked.

Tang Wen covered his head tremblingly, gasped a few times and replied, "The day before yesterday, we ate it when we left." ”

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Plague is a virulent infectious disease that originates in the natural foci of plague. The disease is mainly transmitted by fleas. Animals that are naturally infected with plague can be used as a source of infection for human plague. These include rodents, wild carnivores, wild artiodactyls, domesticated animals, and many more. And the "marmot" mentioned by Tang Wen is called "Himalayan marmot". It is endemic to the Qinghai-Tibet Plateau and is also the main reservoir host of plague in the epidemic area of the Qinghai-Tibet Plateau.

This stout rodent can weigh more than ten pounds, the quality of the fur is very good, and the meat is delicate and delicious, plus it is relatively easy to catch, and at the same time has a strong destructive effect on the plateau grassland. As a result, many herders hunt marmots. On the one hand, the pastures are protected, and on the other hand, they are used for food and for the profit of the fur traffic.

In addition to marmots, marmots, which have recently skyrocketed in popularity, are actually at risk of spreading plague. Sun Lien once saw pictures of some tourists feeding marmots at close range, which looked beautiful, but Sun Lien felt a chill behind his back. If the marmot was infected with the plague, I was afraid that only one or two of the seven or eight tourists who went to feed the marmot would survive.

As a virulent infectious disease, plague progresses extremely rapidly and has a very high case fatality rate. The infections of the Tang family of three all showed obvious pulmonary symptoms. If it is really plague, it is the classification of pneumonic plague in plague. The mortality rate is around 80% and the course of the disease generally does not exceed five days. From the first symptoms to death from multi-organ failure, it usually takes less than 72 hours and is highly contagious. The bloody sputum spit out by the patient's cough and the bacteria-containing aerosols produced during breathing are all sources of transmission.

"There is no colloidal gold used to diagnose plague, and the samples are sent directly to the CDC. The results will come out in about 40 minutes. Xu Yourong was on the side receiving all kinds of information. This is the task given to her by Sun Lien - although she has been working in the emergency department for a month, Xu Yourong is still not particularly skilled in rescue. She couldn't help much with the treatment of this virulent infectious disease. Sun Lien thought about it and simply asked her to be responsible for communicating and coordinating the rescue matters. From requesting consultation to dispensing medications, from reporting to the CDC, to assisting the hospital to set up an airtight door outside the door of the emergency room. In short, these busy and big things are all handed over to Xu Yourong to deal with.

Xu Yourong also did not live up to Sun Lien's expectations, and her coordination skills were extremely impressive - holding three mobile phones and two landline microphones at the same time, and carrying out a mixed input of WeChat voice and text, Xu Yourong actually did not make any mistakes.

"There's no time to wait for the results. Sun Lien frowned and looked at the state of the three members of the Tang family, Tang Wen probably had the advantage of being young, but his parents were not so lucky. Tang Xingde and Hou Huiying's heart rates both exceeded 160, while their blood pressure systolic blood pressure was less than 100, and both of them are currently in shock. The nurses opened four intravenous channels on the two and were rapidly infusing glucose and crystalloid. They are in a very bad state, and no one knows how long the couple will live under the full rescue of the rescue room. "First use the medicine according to experience, and test the skin to see if there is any streptomycin allergy, if not...... Two grams of streptomycin intramuscularly and ciprofloxacin 500 mg intravenously. ”

"Dr. Sun, Dean Song's phone number. "The doctor's order was just given here, and Xu Yourong called Sun Lien to come over and answer the phone. "Can you take it now?"

"Dean Song. Sun Lien took the phone, and on the other end of the landline, Song Wen asked very calmly, "Those three patients, do you suspect that it is plague?"

"The patient had been exposed to a Himalayan marmot in Saihai Province 48 hours ago and had eaten marmot meat. He currently has a high fever of 41°C and severe pulmonary symptoms. According to diagnostic criteria, it is a highly suspected case. ”

"I didn't ask about the diagnostic criteria, Sun Lien, I was asking you. Dean Song raised his voice a little, "Do you think these three people are plague? Could it be pulmonary anthrax?"

"The early symptoms of pulmonary anthrax do not have high fevers, and they progress too quickly to fully match the symptoms of anthrax. Plague is most likely, given the history of exposure. Of course, Sun Lien did not dare to assert that this was the plague - he had not seen a living plague patient.

Dean Song sighed, "Then treat it according to the plague first, I warn you, you are definitely not allowed to take off your mask again this time, do you know that you will die?!"

"Know!" Sun Lien unconsciously stood upright. He already knew how terrible a nosocomial infection was, how terrible a plague infection was. After completing the quarantine, he will never enter the quarantine area without wearing a P4 protective suit.