Streptomycin is a commonly used first-line antibiotic in clinical practice, as an aminoglycoside antibiotic, it is inexpensive to use and has a good effect on anti-infection. The main reason why Sun Lien decided to use streptomycin and ciprofloxacin in combination was based on the plague diagnosis and treatment plan promulgated by the National Health Commission in 11 years.

As a guideline for plague treatment in health facilities, the protocol details the diagnostic method of the disease, the recommended dosage and type of medication, disinfection care, and other arrangements. The maximum dose of intramuscular streptomycin and the combination of ciprofloxacin is actually a very strong anti-infective measure, as far as is allowed. But Sun Lien wasn't sure if the dose was enough — Tang Xingde and Hou Huiying's symptoms were too severe.

"The results of blood routine, blood gas, liver function and kidney function came out, and all three patients had a decrease in platelet count, Tang Xingde had acute liver injury and acute kidney failure, and his wife had acute kidney failure and metabolic acidosis. Xu Yourong shouted at Sun Lien, she saw the inspection data in front of the computer. The paper checklist is still being printed.

"Send the data on kidney function to Zhou Ce and ask for his opinion. "Acute renal failure can range from mild to severe. Not every acute kidney failure needs to be treated immediately. There is always a priority, and in life-threatening conditions, it is important to deal with the patient's respiratory and circulatory problems first. Without kidneys, patients could have died within a few days, and it is estimated that all three had contracted plague two days earlier, and that Yersinia pestisis would have killed them. But without a respiratory-circulatory system, no one can live longer than five minutes.

Deal with respiratory and circulatory problems first, and then turn your attention to the plague. Finally, acute kidney injury and liver injury are treated. This is the right treatment to keep this family of three with the best chance of survival.

Save first, then heal.

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"Streptomycin cannot be used, and the patient has acute renal failure. Zhou Ce called directly to the emergency room, and he also knew that Sun Lien had received three patients with high suspicion of plague, and according to the plague diagnosis and treatment plan of the Health Commission, streptomycin was the preferred recommended treatment drug. However, patients who have already shown impaired kidney function need to avoid the use of streptomycin as much as possible, which is not directly metabolized or reacted in the body, and is mainly excreted by the kidneys. If the patient has renal impairment, the metabolism rate of T1/2 will be extended to more than 100 hours. The human body is exposed to a high concentration of streptomycin for a long time, which may produce serious toxic side effects. After Zhou Ce found out about this, he immediately called the rescue room, and he estimated that Sun Lien was not particularly sensitive to this point. "Treatment with cefpiramide can be switched. ”

Cefpiramide is a third-generation cephalosporin antibiotic. Although there is still little data on the use of third-generation cephalosporins in the treatment of plague, many antimicrobial susceptibility experiments have demonstrated that Yersinia pestis is extremely sensitive to third-generation cephalosporins. Its susceptibility is even higher than traditional anti-plague antibiotics such as streptomycin and gentamicin. What's more, after intravenous cefpiramide injection, blood concentration increases faster than intramuscular streptomycin, and it is mainly excreted through bile, and it can still maintain good metabolism under the condition of renal insufficiency.

"Cefpiramide, huh? Got it. Do you still need to continue to use ciprofloxacin?" Sun Lien trusted Zhou Ce's advice very much, after all, other people's work experience is much richer than his own. Especially the experience of medication in the condition of renal insufficiency, twenty Sun Lien tied together is more than the experience of a single hair without a good strategy.

"Pneumonic plague is a severe case and must be combined. Fluoroquinolones are fine, and the combination of ciprofloxacin is no problem - even if there are minors in the patient, it is not taken care of, and it is better to grow up than to die. ”

Tang Wen is already an adult, so he is not afraid of the cartilage toxicity of ciprofloxacin. Sun Lien adjusted the medication and watched the nurses infuse all three of them with the medicine, and breathed a sigh of relief.

The next work mainly depends on the hospital infection department and the infectious disease department. Of course, because it is pneumonic plague, the respiratory medicine department also needs to support doctors to come down and participate in the treatment work. And the doctors who come to support this have to be selected according to the rules that everyone in the hospital has tacitly in.

Party members, married, with children, and not only children were drawn as the first batch. Ranked down according to the ranks, everyone draws lots together. There are four signatures for the department director, two signatures for the deputy director, and one signature for both the attending and the hospitalization. After drawing lots, I made a phone call with my family to explain a few words, and I had to go to support and save people immediately. This is the rule in hospitals for treating patients at high risk of infection. The doctors who did not be selected as the second batch will draw another person as a preparation, in case the first batch of doctors is drawn because of ...... If for some reason they are unable to continue to perform their duties, then the second batch of doctors will go on top.

In the face of probability, all beings are equal.

"Okay, okay, what kind of lottery do you all get together?" Huang Wenhui, the director of the Department of Respiratory Medicine, unceremoniously dispersed the crowd who were about to draw lots, "What is there to draw here? What should I do, I just go." ”

Director Huang is 43 years old this year and is not tall, about 1.5 meters long. But in the one-acre and three-third of the Department of Respiratory Medicine, Director Huang is the one with the biggest rules. Not only are the rules big, but the temper is also big. With her eyelids down, the best way to deal with a mistake is to admit it before she notices it. If Director Huang finds out about your problem, it won't be a matter of one or two sentences - according to Corey's experience, Director Huang can remember the problem of "the content of the case record is not objective enough" for at least three years. And from time to time take it out to teach a lesson to those who make mistakes.

Such a more serious person is generally less popular. Director Huang Wenhui is no exception. Anyway, according to the rules, Director Huang has four lots to draw, and everyone has no objections. But who knew that Director Huang, who was not popular this time, made such a decision.

"Why do you want to rob it?" Director Huang is from Guangdong, he is dark, thin and short, and he doesn't look like a person who has already given birth to a child anyway. "To let you take care of the plague patients is to harm others and yourself. Maybe they'll be put to death. She glared at her, "If you don't have the ability, don't rob me!"

Everyone in the Department of Respiratory Medicine exchanged glances with each other, and they were not sure whether Director Huang was really angry, or if he was trying to make everyone accept this fact through this statement.

"I am the head of the department, a party member, my child is in junior high school, and I have an older brother at home. Director Huang laughed and poked his hand to his waist, "Which of you can compare to me?" Okay, hurry up and get out, when I come back, I want to check the case!" After finishing speaking, Director Huang turned around, walked out of the office in a very chic manner, and walked towards the stairwell.

After making sure that there was no one around her, Huang Wenhui took out her mobile phone with a trembling hand and called her husband out, and her voice trembled.

"There's plague, I'm going to a consultation. You cook for your children these days. Director Huang's voice trembled very much, "It's okay, I'm fine, I'm ...... I'm not afraid!"

In the year of SARS, Director Huang had just graduated from his bachelor's degree and entered the First Affiliated Hospital of Ningyuan Medical College, which happened to be classified as the designated hospital for the treatment of SARS cases in Song'an Province.

That's what Mr. Hou said back then. He did it, I ...... I can do it too!" Director Huang said this sentence and hung up the phone resolutely. He wiped his eyes with his sleeve, stomped his foot, and ran towards the emergency department's emergency hall.

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"As a member of the Communist Party, I have only this privilege. Professor Hou Youning, who was the director of the Department of Respiratory Medicine in the First Affiliated Hospital of Ningyuan Medical College before his death, said at the time, "When I can't do it anymore, you will draw lots!"