Back in the Fourth Hospital, Sun Lien and Dr. Brunn were tired like dead dogs. This business trip was too busy, so busy that the two of them were physically and mentally exhausted, and they wanted to sleep to death.

However, the follow-up report that needs to be done still needs to be done. It's not like someone will do it for you just because you're both tired. Like what...... Wong Ping-yin undergoing interventional treatment.

In the 48 hours that Sun and Dr. Brunn left the Fourth Hospital, Wong Bingxian fell into a near-death state several times. After the bacteria that infected his lungs entered his heart with the bloodstream, a large number of bacteria began to multiply at his heart valves. In addition to blocking the closure of the heart valves, the valve vegetation also eroded his heart valves. After a severe ventricular fibrillation, the Fourth Hospital confirmed that Wong Bingxian had severe third-degree insufficiency at the aortic valve through cardiac ultrasound.

While the aortic valve is not fully closed, the vegetation on the heart valve is also falling off. When Sun Lien arrived at the Fourth Hospital, he happened to meet Huang Bingxian being pushed out of the rescue room by Xu Yourong and others, and ran towards the CT room.

"Splenic infarction" Sun Lien glimpsed this state at a glance, and sepsis is still there.

This is...... The bacterial embolus caused by sepsis caused by splenic artery embolism, right? Sun Lien looked at Huang Bingxian who was pushed away expressionlessly, although he had the intention of following to see the situation, but his two legs just couldn't move away - he was too tired.

"We've got you covered. Yuan Ping'an saw Sun Lien standing in place and shouted at him, "You go back and rest!"

The Fourth Courtyard, which is in the rear, has been busy for the past two days, and it is conceivable how busy Sun Lien and them have been on the front line. Even if there is no status bar, Yuan Ping'an can see that Sun Lien's tired brain is now wooden. Without hesitation, he blasted Sun Lien back to the dormitory. With his current state, even if he had any diagnostic opinions, Yuan Ping'an didn't dare to listen to them - the ghost knew if his judgment was an illusion that was tired.

Sun Lien didn't know how he got back to the dormitory, and he didn't know when he lay down. When he opened his eyes again, not only did he not feel that he had recovered his state, but he even felt more tired - the sky outside was gray, and Sun Lien couldn't tell whether he slept from night to early the next morning, or directly to the next afternoon.

There are no unread messages on the phone, which is the first focus of Sun Lien's attention. And then there's time...... It's seven o'clock in the morning.

Get...... That's how powerful habit is. Sun Lien slowly got up from the bed, he really couldn't sleep and didn't want to continue sleeping. In addition to habit, there was another important reason why he decided to go to the hospital early in the morning - he was on a business trip in Panjiang City for the past two days, and the wound was not dressed.

It's not going to be scraped again, right? Sun Lien felt a little chill when he thought of this.

As usual, Sun Lien slipped downstairs, but this time he bought meat buns - more than double the usual vegetarian buns, and there may not be any good meat in the buns. After all, according to general experience, most of the meat buns sold on the market use pork leftovers. But meat is a thing that is especially suitable for the cold winter. After eating the four buns in his hand, Sun Lien only felt a little more strength in his body, and his stomach gradually felt a little full.

The impact of the chaotic rescue on the Fourth Courtyard was smaller than he imagined. Although there are still some hurried staff walking around the rescue hall, at least the order has been restored. The routine shift handover every morning is also being exchanged as normal, rather than the collective rotation of the second-level emergency response mechanism.

“...... That's probably the case. Zhou Jun closed the medical record folder in his hand a little tiredly, "Except for the three surgeries that need to stabilize the injury and electively perform, all the other people's surgeries have been completed." ”

Including Sun Lien's treatment team, all the medical staff in the emergency room gathered around Zhou Jun and quietly listened to his report. Although the two days were tiring, I finally got the best result. In addition to the relaxation that things are over, everyone is also sincerely happy with the feedback on the treatment results - so many patients have been sent to the four hospitals, and there is not a single fatal case. It's almost indistinguishable from a miracle.

"As for the special patient ......" Zhou Jun didn't finish his words, he turned his eyes to Sun Lien, half describing the situation and half reminding, "The experimental drug has been used for four days, and although the new antibiotic is very effective for infection, his physical condition is still very unoptimistic." ”

There is no doubt about the antibacterial properties of apomycin, but that doesn't mean it can solve all of Wong's problems. To some extent, it could even increase the danger to Wong. While apomycin kills bacteria in large quantities, it also causes the vegetations entrenched in Wong's heart to peel off. On the one hand, these peeling vegetations can expose the cannibalized heart valves, causing further decline in heart function, and at the same time, they can randomly block blood vessels throughout his body, causing unpredictable organ avascular necrosis or limb gangrene.

"What is now certain is that the particular patient now has avascular necrosis of the spleen. Xu Yourong added to Zhou Jun's report, "But due to the nature of the emboli, we are unable to further treat this area." Either surgical excision of the necrotic site or interventional revascularization is not possible. ”

In the case of severe infection, surgery is almost equivalent to death. However, after the bacterial plug is dredged by interventional surgery, because the embolus cannot be completely peeled off, a large part of the bacterial plug will inevitably be broken into smaller pieces and re-enter the blood circulation, and cause a larger range of random tiny blood vessel blockage, so it cannot be carried out.

"At the moment, only conservative treatment can be done. Xu Yourong concluded, "After communicating with clinical pharmacists and experimental units, they suggested that the dosage of apomycin should be increased from the current 0.5 mg each time to at least 2 mg each time, and the dosage should also be increased from two to three times a day. ”

In other words, the dosage of apomycin should be increased from 1 mg per day to 6 mg per day. The dose of the drug was increased sixfold in one go.

"At the same time, I recommend preparing the patient for ECMO treatment. At the very least, be prepared for this. Xu Yourong continued to put forward his own suggestions, "Judging from the current cardiac color ultrasound situation, the decline of the patient's heart function has become a foregone conclusion. After increasing the antibiotic dosage, we were faced with a severe decrease in ejection fraction in a very short period of time. Combined with his current lung infection, if there is no ECMO support, after the high-dose antibiotics take effect, it will be the beginning of the patient's death. ”

Xu Yourong used a more abstract way to describe the severity of the situation, "The patient's underlying medical condition determines that he is not eligible for an organ transplant, and his current physical state is not suitable for valve replacement." There is no second treatment that can be used other than ECMO. ”

Zhou Jun pondered for a while and then said to Sun Lien, "You contact the relevant departments, after all, the cost of ECMO treatment is very high." If they can't afford it, then prepare in advance. ”

What type of preparation is made in advance, this does not need to be said clearly, Sun Lien himself knows it in his heart. As for whether the relevant departments can accept the cost of ECMO treatment...... Sun Lien was more inclined to not be able to. After all, they don't produce benefits on their own, and all the money comes from financial allocations. The cost of treatment during this period alone is enough for them to have a headache. No matter how valuable Huang Bingxian is, it is really difficult to treat him with an almost invisible ECMO. The start-up cost is almost 60,000 yuan, and the maintenance cost is even more exaggerated. Patients like Wong Ping-yin, who have a severe infection of unknown bacteria, fungal pneumonia and HIV at the same time, will need at least about 20,000 yuan a day.

The average operation time of ECMO is at least 10 days, which means that Huang Bingxian receives an ECMO treatment, and the relevant departments have to pay at least 260,000 yuan. According to statistics, about 30% of patients who have undergone ECMO treatment survive.

With tight financial funds, gamble on whether a criminal suspect who may have interrogation value will survive with a 30 percent chance of survival? Taxpayers' money is not spent so recklessly.

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"This ...... We really can't help it. Sure enough, after hearing Sun Lien's introduction to the situation and the cost of using ECMO, Captain Wu first made a difficulty, "How much is our case handling fund for a year!"

"That's the situation now......" Sun Lien said helplessly, "Without money, Huang Bingxian will definitely not be able to save him, and if he has money, he may not be able to survive." He paused and continued, "Since we don't have any money, then I'll continue to rule according to the current situation...... Maybe there will be a miracle?"

Captain Wu coughed twice, "Miracle? If that kind of thing is so easy to appear, then it's not called a miracle." His voice sounded dejected, "I don't care about anything else, it's just a pity that I haven't had enough confessions out of his mouth......"

It's a topic again. Sun Lien rolled his eyes, Captain Wu used this as a reason to force Sun Lien and the treatment team to treat Huang Bingxian. Now I repeat the same old tune, although I certainly don't mean to continue to be embarrassed for myself, but it always sounds a little unpleasant.

"Captain Wu, I think your thinking may need some change. Sun Lien interrupted the other party's complaint, "Huang Bingxian shouldn't be the only one who knows about these things." His little brothers will know more or less about it, especially ......" Sun Lien recalled a little, and found out from memory what color the grandson's hair was that had stabbed him," ...... The purple-haired guy. ”

"Oh?" Captain Wu didn't expect Sun Lien to give him advice in this regard, because of his professional habits, he immediately asked, "How do you know?"

"When I stormed the emergency room, except for Huang Bingxian, it was the purple-haired guy who was the most excited. Sun Lien considered the words, at that time, although the rainbow men's group was all in the style of "I am Hong Xing's bar", the other five people at least did not take the initiative to attack, only Huang Mao and Zi Mao's movements were the most intense - the others were even a little surprised when they saw Zi Mao take out a knife. "He acted more violently than even the other five. ”

"This is not direct evidence. The interest that Captain Wu had just mentioned was suddenly diminished a lot, "Forget it, since it's already like this, there's no way." We can only see if we can dig up any valuable information from others. ”

Sun Lien hung up the phone and rolled his eyes again, but this time it was for himself.

Who says a good doctor has to be a good detective?