Days are a strange thing. Sometimes, every second of the day seems as long as a year. And sometimes, half a month is just a blink of an eye.

And Sun Lien's experience these days is like a blink of an eye.

Since the duty time was adjusted to be the same as Zhou Jun, Sun Lien suddenly had a lot of free time. No kidding, the third-line doctors suddenly enjoyed the frequency of front-line doctors on duty. From working six days a week to working three days a week, there is no one who can adapt to this change at once.

It's just that adjusting the order of duty does not mean that Sun Lien can completely herd sheep. Every Monday, Wednesday and Friday, I went to the hospital with Zhou Jun, and on Tuesday, Thursday and Saturday, I had to go to the laboratory to soak in it. Originally, there was one day off a week, but now it's good, and I don't even have time to catch my breath.

Of course, Sun Lien is a little dissatisfied with this arrangement, and no one would like to work seven days a week. But Sun Lien couldn't directly express his dissatisfaction no matter what, for a simple reason - Zhou Jun did the same.

Sun Lien himself has not made a proposal report, and no one has come to tell him what project he should study. As an associate professor in charge of teaching in Liu Tangchun's laboratory, Zhou Jun is usually responsible for opening questions. But Sun Lien will only enter school next year, and now there are really no projects in the entire laboratory that can be handed over to him.

After thinking about it, Zhou Jun decided to let Sun Lien participate in a project that was almost completed. At least let Sun Lien initially start to get in touch with scientific research projects first, and gradually build up some experience. In this way, when he is transferred to other projects, Sun Lien will not be like a headless fly.

"So you're mainly engaged in cardiopulmonary resuscitation research now?" In the dormitory, Dr. Cao and Sun Lien sat in the living room, with several bottles of beer on the table in front of them. The photo in Sun Lien's circle of friends has been sent out for half a month, and the impact is not something that can be said in a few words. Dr. Cao was a little overwhelmed - the whole lab knew that he usually had to kneel and talk back when he messed with his girlfriend. Therefore, Dr. Cao decided to treat Sun Lien to a drink, and then coerced him to delete the photo. It's just that this purpose seems to have been forgotten by him for a long time, and he began to be curious about the projects Sun Lien participated in.

"I'm actually a handyman. Sun Lien took a sip of beer, tomorrow is Sunday, he doesn't have to go to the hospital on duty. So there's no psychological pressure to drink. "Brother Xu's research data has basically been collected. My main job now is to make regular phone calls to the families of patients who are being used as research data. ”

Brother Xu's name is Xu Shengyong, and he is a student of Liu Tangchun. As a graduate student in the field of cardiopulmonary resuscitation in emergency medicine, his research project is very straightforward - "Analysis of the Effect and Influencing Factors of Cardiopulmonary Resuscitation in Emergency Department".

Cardiac arrest (CA) is the most critical clinical condition in which the blood supply to the whole body is interrupted when the ejection function of the heart suddenly stops and the mechanical activity of the heart completely disappears. When the blood supply to the brain is interrupted for about 10 seconds, consciousness is lost. It is generally believed that the brain will suffer irreversible damage if the heart stops beating for more than 5 minutes, and more than 95% of the brain tissue will be damaged if it stops beating for more than 15 minutes. Therefore, in medical clinics, there is no disease state more than cardiac arrest, which is also the last common clinical channel for many critically ill patients. Cardiopulmonary resuscitation (CPR) is the most important and the only emergency medical treatment to save a cardiac arrest patient.

And cardiac arrest is not simply "the heart is not beating". According to the ECG, there are four types of cardiac arrest, namely ventricular fibrillation (VF), pulseless ventricular tachycardia (VT), pulseless electrical activity (PEA) and cardiac arrest (ASY). Of these, VF and VT can be treated by defibrillation, so these two types of cardiac arrest are also known as defibrillable heart rates. PEA and ASY are non-defibrillable heart rates. So, unlike most people think, not all CPR treatments use a defibrillator.

However, after almost half a century of modern CPR technology, the overall mortality rate of patients with cardiac arrest has not been fundamentally improved. According to a multicenter study in North America, among the 20,520 patients with out-of-hospital cardiac arrest (OHCA) they included in the evaluation, survival at hospital discharge ranged from 3.0% to 16.3% at each center. In total, only 954 patients (4.6%) were discharged from the hospital in total.

Yes, in North America, where CPR is widely introduced, less than 5% of patients who suffer from cardiac arrest outside of hospitals make it out alive. In 03, a total of 4,166 OHCA patients were treated in the Shanghai Emergency Center, and a total of 143 cases of pre-hospital spontaneous circulation recovery (ROSC) were treated, and only 1 case (0.02%) was discharged from the hospital in the end.

In film and television works, the scene where the heart stops beating and chest compressions and artificial respiration, and finally the handsome electrode plate is put on the person's chest, and the scene where the electricity can save the person back is actually a real minority. Ventricular fibrillation (VF) due to myocardial infarction is relatively easy to manage. The "chest pain center" hanging in the major emergency centers is actually specially designed to treat patients with acute myocardial infarction.

Sun Lien's exposure to the data during this period is actually very shocking, he has been working in the emergency department for more than two months and almost three months, although several patients have passed away, but in general, there are still good results. Therefore, when he saw the 0.02% data, Sun Lien's first reaction was, "Is this data wrong?"

But the data doesn't lie, Xu Shengyong's data was collected from the emergency department of the Fourth Central Hospital. During the four-and-a-half-year study period, there were 730,000 emergency patients, more than 13,000 people were kept for observation, and 14,000 patients were rescued, with a rescue rate of 1.9%, of which 1,936 were cardiac arrests, accounting for 2.6‰ of patients and 13.6% of patients were rescued. A total of 597 people were included in the study, with a mean age of 5.95±17.9 years, with the oldest patient being 103 years old and the youngest being 18 years old.

In the rescue of the Fourth Central Hospital, after cardiopulmonary resuscitation, 36.7% of them were able to achieve spontaneous recovery of circulation, but only 3.2% were able to survive and be discharged. The most valuable effect of CPR, with good neurological survival, accounted for only 2.7% of all cases studied.

Of the 597 people, only 16 had good neurological function and survived and were discharged. This is the achievement of the Fourth Central Hospital, the largest emergency center in the region, and the pilot unit of the major emergency department in the past four years. As for those who were not included in the study, with the exception of a dozen patients younger than 18 years old who were excluded because they did not meet ethical scrutiny, most of the patients were discharged voluntarily after their families refused to be resuscitated, or their hearts went into cardiac arrest. It can be speculated that their endings are basically death. In other words, in the past four years, about 1,900 people have been admitted to the Fourth Central Hospital for cardiac arrest, 16 of whom were able to complete activities such as eating, dressing and going to the toilet without the help of others, and the other three survived with severe nerve damage.

Is CPR really necessary? Sun Lien looked at the data in his hand and fell into confusion again. He did CPR, and Zheng Guoyou was pressed by Sun Lien. The old man probably belonged to one of the very lucky 2.7%, and he showed almost no neurological sequelae.

Wu Fenmei, who contracted avian influenza, was transferred to the Second Hospital for intensive treatment after her condition stabilized. What the specific situation is, Sun Lien doesn't know - when Wu Fenmei was transferred, Sun Lien was still playing with his mobile phone in the isolation room. But at least, Sun Lien can be sure that before he fainted, Wu Fenmei recovered sinus rhythm. She was also lucky, at least more fortunate than the 63.3% of patients with cardiac arrest. For a long time, a large dose of adrenaline, and multiple electrical defibrillations, in this case, he can return to the state of sinus rhythm, Sun Lien didn't think he was doing well at first, but under these data, he had to re-examine the advantages brought by the status bar.

Could it be that if there are times of prompting, the patient's spontaneous circulation will definitely be restored?

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It didn't take long to drink, Sun Lien opened a total of seven bottles of beer, and Brother Cao couldn't bear it - four of them were drunk by Sun Lien himself.

"You dare to come out and drink with others for the amount of three bottles of beer?" Sun Lien really saw someone drink a bottle of beer for the first time, and he couldn't bear it. Brother Cao wanted to vomit after drinking three bottles of beer in fifty minutes, and even made Sun Lien wonder if his roommate had taken antibiotics before drinking beer - a disulfiram-like reaction prevents the body from metabolizing alcohol, causing alcohol to accumulate in the body, and this reaction can be fatal.

It's just that under the double confirmation of the status bar and the inquiry, Sun Lien determined that Dr. Cao was just a simple poor alcohol drinker. This reassured him a lot.

Carrying Dr. Cao to the room, Sun Lien walked to the balcony. He looked at the moon in the sky, and the white air coming out of his mouth was like a cloud blocking the soft moonlight.

Doctors are human too, and frustration and self-doubt are inevitable when straightforward research data seems to mock him for the futility of everything he does.

The moonlight had a faint tendency to intensify, and the cold north wind made Sun Lien, who was thinly dressed, suddenly sober up.

No, how could it be useless? Without those ten minutes of chest compressions, Zheng Guoyou would have become a martyr long ago. Without eleven defibrillations, Wu Fenmei would definitely have passed away on her birthday. Even under the research data, 3.2% of patients survived because of cardiopulmonary resuscitation.

If it weren't for the doctors' best efforts, these 19 people would not have survived.

The job of an emergency physician is like this, not everyone will be saved, but those who are saved will survive because of the doctors' full treatment.