Xu Yourong and Penny have a really good relationship. After hearing this request, she nodded without even the slightest hesitation, "No problem, I'll just pick it up." Not only that, but she also thought about the future very intimately, "I think they may not be able to go back today, so I'll open a room directly in the hotel over there in Sun City." Pascal is expected to spend the night in the hospital today, and he will have to find a place for Isabella and Penny to sleep. ”

When a family suddenly encounters such an accident, almost all the members of the family will have their daily lives lost. Penny and Todd went to the same school, and probably already knew that her brother had been sent to the hospital. It's time for school to get out, and the little girl doesn't know what to worry about.

I have to say that the ability of women to soothe people when facing children is simply beyond the reach of men. Sun Lien can accurately find out what makes him/her uncomfortable when facing a crying child, but he can't coax a child who "wants a mother" in a few words like other nurses.

In order to let Xu Yourong pick up Penny as soon as possible, Brune was very enthusiastic to provide his own motorcycle for Xu Yourong to use. The most surprising thing is that this unmarried member of the American Communist Party actually put a children's helmet in the car.

In Brunn's words, this is called "having a sense of distress."

However, this proposal was dissipated after Sun Lien popularized the traffic rules to Brunn. Children under the age of 12 are not allowed to ride on motorcycles due to domestic regulations. In the end, Xu Yourong could only borrow Sun Lien's Volvo, and he had to drive to Dr. Pascal's house first and get the child seat.

Although troublesome, Xu Yourong showed no signs of impatience.

On the contrary, Sun Lien was a little impatient in the office of the director of the infection department.

"What's going on with this medication, why do you want to pulse it?" Director Huang is a typical technocratic hospital department manager. The level of business proficiency in their direct jurisdiction is not bad. But when the business involves cross-departmental, he will show a very rigorous professional attitude - at best, at worst, he is always skeptical of the professionalism of other departments, and every detail that can be picked has to be picked to death.

This kind of rigor is considered an old and serious move when there is enough time to consume. But when Qian Aiwu was waiting for medication to fight necrotizing fasciitis, it was a little inappropriate.

"Director Huang, the opinions of other doctors in the pharmacy department and the infectious disease department are below. Sun Lien carefully reminded, "I am an emergency physician, and I can't answer the questions you ask." He took a breath quietly and tried to calm his emotions, "The medication plan is designed by a licensed pharmacist in the pharmacy department according to the patient's condition, and I don't know the specific reasons. ”

"Then I'll make a phone call first. Director Huang nodded, and his face did not show any dissatisfaction. "This permission involves the management regulations of our hospital, so I have to figure it out before I can sign it. ”

Sun Lien blinked his eyes in pain, and what Director Huang said was not wrong in a word. But it is this meticulous energy that really makes people who are waiting to do things feel anxious from the bottom of their hearts.

"Hey, Sun Lien?" Sun Lien's phone rang, but fortunately, the mobile phone kept pinching in his hand, so that Sun Lien could connect the phone with lightning speed before the word "baked" of "baked gluten" was completely called. The speed was so fast that even Director Han, who was on the phone, was a little surprised. He was stunned for a moment before continuing, "Director Huang is back, right?"

"It's back. Sun Lien replied with a bitter face, "Director Huang asked a lot of questions about medication, but I couldn't answer any of them." As a result, Director Huang said that he had to make a phone call first......"

Director Han Wenping laughed twice, "Don't take it to heart, Lao Huang has such a stinky temper." Even if Dean Song is moved, it is useless. He said in a low voice, "I'll let people send the medicine to you first, and Lao Huang will definitely sign it, just a little more delay." ”

Director Han is famous in the Fourth Courtyard, and Sun Lien still has some concerns and intends to persuade him to wait, but Director Han has already hung up the phone in advance.

Although he was a little worried that it was inappropriate for Director Han to do things so directly, Sun Lien was actually a little happy in his heart. At least now that he knows that Qian Aiwu's treatment will not be delayed, he feels a lot more at ease.

However, it was the first time that Sun Lien met the department director who "it was useless to move Dean Song". Song Wen's control over the following departments is beyond doubt. Even Zhao Weiguo from the laboratory department didn't dare to directly confront Song Wen - he didn't even dare to directly confront Liu Pingchuan. But Director Han never spoke with moisture. If he wants to say it's useless, it must be really useless.

Why does Director Huang Hua have such confidence? Sun Lien was a little confused, but he was sure that this confidence was not because of his background or identity—just because of Dean Song's temper, he still cared about his identity when he became popular?

"There's a bit of a problem with this medication regimen. Sun Lien was trying to guess the source of Director Huang Hua's confidence, and Director Huang, who was sitting behind the table, suddenly frowned and spoke, "Why did you use so many standard diaphragm bag nutrient solutions for her?"

Standard diaphragm bag nutrient solution is the main means of caloric replacement in clinical treatment for patients with feeding difficulties. For patients who are unable to eat on their own for a long time, fat emulsion injection is the best and only means - you can't always starve to death because the patient can't eat because of a coma, right? If it's just a short-term coma, then you can simply maintain it with glucose injection. But patients like Qian Aiwu, who are in stage 3 cancer surgery, have severe co-infections, and then fall into a coma, have a much higher need for calories than ordinary people or even other patients. Her body will need nutrients more than usual to get better as soon as possible.

"Uh......" Sun Lien was really stunned for a while after hearing this question before replying, "Her nutritional needs are higher than those of other patients......"

"I knew she needed more calories. Director Huang Hua continued, "My question is, why use a standard diaphragm bag instead of dividing the input? She was in septic shock before, right?"

"Nutritional support strategies are developed based on gynaecological recommendations. Sun Lien also vaguely sensed that Director Huang Hua's problem might be important, "According to our calculations, the total amount of calories she consumes every day is enough - 4000 kAl...... per day"

Director Huang shook his head a little disappointed, and muttered to himself, "Why didn't you come to see me earlier, why didn't you ask the nutrition department to make a nutrition plan?" He raised his head and looked at Sun Lien and said, "Although the consequences of this problem may not have been reflected yet, if you continue to do this, even if you really change the medicine, she may not be able to wake up well." ”

"What do you mean......" Sun Lien was really a little panicked, he tried to recall, when he went to see Qian Aiwu in the past few days, the status bar did not indicate the problem of malnutrition.

"You guys, you are too light on nutrition, too credulous about numbers!" Director Huang shook his head as he took out a stack of materials from the filing cabinet beside him, "Fortunately, it's not too late for you to come to me." Drag on another week, and this man will have to make you hungry!"

For patients with severe septic shock, Director Huang's experience is by no means worse than that of the emergency department. And when the scope of expertise is focused on nutritional support and long-term treatment, the emergency department is even worse than Director Huang.

"Such a patient is in a state of severe stress. Director Huang Hua pointed to the stool on the side and asked Sun Lien to sit down. I flipped through the information, and I looked like I was going to teach Sun Lien a lesson. "The gynaecological nutrition regimen is a standard diaphragm bag nutrient solution of 4 kilocalories per day. This regimen is barely enough for patients who have undergone radical tumor resection. But she also has necrotizing fasciitis, which requires at least 5,000 calories and a little more protein. He raised his head, looked at Sun Lien and shook his head again, "Only use the standard diaphragm bag nutrient solution, the calories are enough, there is too much fat, and too little protein." In order to synthesize enough protein to repair her body, her body consumes a lot more calories. Speaking of this, Director Huang seemed a little regretful, "It's common for you to come from the emergency department and don't understand this, and the doctors in the ICU don't bother to ask the nutrition department for consultation." But this habit is not good, very bad!"

According to general statistics, only 29% of patients treated in the ICU receive sufficient energy. The majority of patients are inadequate, and about 56% of these patients do not have adequate protein intake. This is partly due to the irrational early prescription of enteral nutrition (EEN), delayed enteral nutrition (DEN), and disruption of enteral nutrition due to various reasons. The main reason is actually because of the widespread promotion of standard diaphragm bag nutrient solution.

The standard diaphragm nutrient solution is a good thing, as it comes pre-packed with a mixture of fat emulsion, amino acids, and glucose. It is only necessary to squeeze the diaphragm in the bag before injecting the patient to allow the nutrient solution to mix evenly before use. The shelf life of the standard diaphragm bag nutrient solution at room temperature is up to 24 months, which is convenient for mass production and storage, and more importantly, it avoids various contamination problems that may be caused by the homemade nutrient solution in the hospital in the past.

But this kind of standardized production often has nothing to do with "individualized treatment". The standard diaphragm bag nutrient solution produced according to the standard table cannot actually meet the protein needs of many patients with severe stress. Moreover, because the nutrient solution is directly injected into the blood vessels, patients with cardiovascular and cerebrovascular diseases, as well as patients with metabolic disorder syndrome, cannot use this nutrient solution.

Doctors in the ICU are highly concerned about the condition itself, but often neglect to provide nutrients. In fact, the vast majority of hospital departments have this problem. However, most of their patients are able to feed themselves, and even if there is a nutritional deficiency that they are actively given, the patients are able to consume food on their own.

Although there is still debate about whether EEN should be applied to patients with shock, at least one thing Director Huang can be sure of is that Qian Aiwu is now eating not enough calories and the nutrients he is eating are not balanced. This may be one of the main reasons why her infection is still not getting as good as expected.