"So you're back?" Liu Tangchun half-leaned back in his seat and looked at Sun Lien in front of him with sympathetic eyes. He really felt some sympathy for this disciple of his own. Accidents happen every day these days, and I really don't know which way this kid collided with the immortals.

Sun Lien had a bitter face, not knowing whether he should put on a pitiful expression, or simply pretend not to care about being generous. He has decided that after the busy past few days, he will go to a famous mountain and ancient temple to pay a good respect, in order to wash away this inexplicable unlucky energy on his body.

"Alright, alright. Liu Tangchun waved his hand, "Go sleep in the duty room." He suddenly thought for a while and said, "Xiao Xu is on duty today, you go over to say hello to others, and if necessary, change the duty with others." After all, Xiao Xu is a lesbian, and she is a doctor outside the gods......" Liu Tangchun paused and continued, "Usually these doctors outside the gods are held in their hands as treasures, but now it's good, they still have to work the night shift on the front line when they come to me......

Neurosurgeons require the hand to be steady and the heart to be heavy. From the beginning of their university education, professors have instilled in their students the idea that neurosurgeons should not only avoid physical work as much as possible, but also ensure adequate rest time. After all, the surgical precision requirements in the field of neurosurgery are terrifying, and with a slight shake of the hand, the patient's life may have to be explained on the stage. Insufficient rest and overuse of muscles can lead to poor hand movement accuracy. Therefore, this condition can even be considered taboo.

However, Xu Yourong doesn't seem to care about this at all, since he came to Sun Lien's treatment group, Xu Yourong has been on duty for two night shifts. Moreover, he is also very active in the usual rescue process, and there is no awareness of "avoiding manual labor" at all. It's no wonder that Liu Tangchun felt a little reluctant. This is why Sun Lien was asked to share the pressure on duty - after all, Sun Lien is not a miracle surgeon, even if he is tired and his hands are shaking, he will not delay chest compressions.

Sun Lien wandered to the rescue room and said hello to Xu Yourong. In the rescue room, a group of doctors on duty expressed their cordial "condolences" to Sun Lien. And everyone thinks that Sun Lien has been unlucky recently, and the main reason is that his character has been exhausted on Hu Jia. If you want to transfer, it's only right to invite everyone to dinner quickly.

"You go and rest first. Xu Yourong looked at his watch, it was half past eight in the evening, "It's just right, you sleep for four hours, and you get up for me at half past two." Then I got up again at half-past six to take over, ready to do a handover with the day shift doctor. ”

It's actually easier to get through the first half of the night than the second half. But Sun Lien will certainly not be dissatisfied with this arrangement, after all, the two people sleep for the same length of time. And after 2 a.m., fewer patients are usually sent to the hospital.

Taking off his coat in the lounge, Sun Lien got into the quilt and began to urge himself to fall asleep. Xu Yourong sat on the duty desk outside, lowered his head and flipped through the information that Dr. Pascal had finished reading in the afternoon.

"Jingle bell!" After reading the information for only half an hour, the red phone in front of Xu Yourong suddenly rang. She took the phone with her left hand, closed the information in front of her with her right hand, and then took out a pen to prepare to record, "The emergency room of the Fourth Central Hospital, what's the matter?"

"Got it. Five seconds later, Xu Yourong hung up the phone and said to the nurse Zhong Yu on the side, "Predict a patient, unconscious, no obvious trauma, low-grade fever, and difficulty breathing." Ten minutes later at the hospital. ”

Zhong Yu nodded and took out a new protective suit from the cabinet next to him. The patient previously admitted to the Second Hospital has been confirmed to be infected with H7N9 avian influenza, and according to the plan, the whole city of Ningyuan is currently in the level IV public health emergency response mechanism. All hospital emergency departments should refer patients with high fever and respiratory symptoms to a fever clinic for isolation and diagnosis. Once the diagnosis is confirmed, the patient should be immediately referred to a designated hospital for treatment.

The patient predicted on the phone had difficulty breathing, but his body temperature was a low-grade fever, i.e., the patient's temperature was below 38 degrees. According to the regulations, it is not necessary to send to a fever clinic for treatment. However, in accordance with the regulations, and also for the safety of medical staff, the Fourth Central Hospital will still require doctors to take adequate protective measures when receiving such patients.

Disposable transparent protective glasses and N95 masks are necessary protective equipment. And these protective products, which obviously exceed the requirements of the regulations, are naturally sponsored by Dean Song. More than one-fifth of the funds that Mine and Billiton sponsor to the Fourth Central Hospital each year are spent on these sites.

"Take the patient straight to the cleanroom. "The infectious disease department of the Fourth Central Hospital is much higher than the hospital infection department of other hospitals at the administrative level. Moreover, their continuous propaganda (threat) in their daily work, coupled with the power to deduct people's performance, has indeed made many front-line medical workers more careful, after all, the virus is more likely to survive in the winter environment than under other conditions. In order to prevent the cold, people rarely open windows to ventilate in winter, and this series of objective factors will indeed lead to a high incidence of infectious diseases. Therefore, Xu Yourong still arranged the room and route for isolation and examination, although she did feel that since the patient's body temperature had not yet reached 38 degrees, the significance of this measure did not seem to be very great.

The preparation is proceeding in an orderly manner, and by the time the patient is sent to the emergency room, the other patients in the transport aisle have been evacuated to the positive pressure area of the emergency room. Starting from the electromagnetic door of the rescue room to the clean room, all 12 beds in the passage are empty.

"The patient was female, about 50 years old, undocumented and unconscious. Blood oxygen saturation 92%, blood pressure 110/155, heart rate 120, body temperature 37.4°C. "The pre-hospital emergency face that rushed into the emergency room with a gurney was covered with an ordinary mask, probably because of the heavy breathing, the mask on the pre-hospital emergency face was blown off half, exposing two nostrils. I don't know what the meaning of this mask is. He pushed the car in with his head down and pointed to the police officers who were following behind him, "The patient was found fainting on the side of the road with no obvious external injuries on his body. Then passers-by called the police, and comrades from the police station rushed to the scene and called the emergency number. ”

"How long have you been unconscious?" The patient was wheeled directly into the clean room under the guidance of the nurse. Xu Yourong put on blue latex gloves and used a small flashlight to check the patient's pupil response. "Have you found your family?"

"Not yet. The policeman who entered the clean room with him didn't look very old, and he was probably a rookie who had just graduated from the police academy. He answered Xu Yourong's question a little nervously, "We received the alarm 20 minutes ago, that is, about eight o'clock...... Around eight forty. He simply pulled a small notepad out of his pocket, looked at its contents, and nodded affirmatively. "We got a call at 8:40 a.m. and arrived five minutes later when the man was lying on the ground. ”

Xu Yourong turned around and said after completing the basic examination, "Please go with our nurse and register her first......" Speaking of this, Xu Yourong suddenly didn't know what to continue to say. After all, this patient doesn't even have a name, and this registration really doesn't know what to do.

"I'll just take him with me. Zhong Yu volunteered, she had been working in the rescue room for a long time, and she knew that she was in trouble when she saw Xu Yourong's appearance. "I'm quite familiar with the registration process for patients who don't have an identity. ”

In fact, many patients who cannot obtain identity are seen in the hospital every year. Some of these people are mentally ill, some are wanderers, and some are truly desperate. And for these patients, if emergency treatment is required, the hospital will still accept them. and medical assistance is given within a certain range. And this process is called the "unidentified patient treatment process".

It is important to note that this emergency service is limited to patients who need emergency care. Unidentified patients whose condition is not in urgent need will be given priority to the Civil Affairs Bureau's shelter rather than the hospital's emergency department. After confirming that the patient is in urgent condition, the medical staff will report to the medical office and register the arrears, mark the patient as "anonymous", and write "help" on the bed card. If an emergency examination of the patient is required, it is also marked as "anonymous".

If it is not possible to verify the patient's identity in the end, the expenses incurred in this series of medical treatments will be paid by the Emergency Relief Fund every six months.

When Zhong Yu was in the triage table before, he often dealt with such patients. Now in the emergency room, the ability to deal with the situation has not been left behind. She took the little policeman out to register, while Xu Yourong continued to check the patient's physical signs.

Anonymous's tridental syndrome is very obvious. Although she has been receiving oxygen in the ambulance, her oxygen saturation is still only 92%, which is not optimistic.

"Are you inhaling pure oxygen now?" Xu Yourong and Xiao Guo frowned after confirming the situation, "Call and ask the imaging department to come and take a bed film." In order to grab a little time, Xu Yourong gave instructions while still doing other physical examinations. "Check a whole blood, put on the 12 leads, pull an ECG to look at it, check a big biochemistry, and add five infections......" She paused, patting Anonymous's shoulder with both hands, "Wake up! Do you know where you are?"

Anonymous's eyelids moved, and he seemed to have some reaction to the pat on the shoulder. But he never opened his eyes.

Doctors from the imaging department quickly arrived at the scene. This time it was not Luo Ge who came, but another middle-aged radiologist surnamed Huang. After learning the basic situation, he also put on a mask.

"Is it okay to take a chest X-ray?" Dr. Huang skillfully pushed the bedside X-ray, he frowned and looked at the patient and asked, "Do you want to wait for an emergency CT?" ”

"Let's take a chest X-ray first. "The senior auxiliary department doctors are indeed very sensitive to certain diseases, but Xu Yourong does not think that this anonymous person has problems such as cerebral hemorrhage. The patient's pupils respond well to light, and the pupils do not appear dilated or asymmetrical, at least for now, cerebral hemorrhage is unlikely.

The results of the bed radiographs were quick and the x-rays confirmed that the patient had atelectasis on one side of the lung, and at the same time, there were lesions on the radiographs with infiltrates in the middle lobes and lower lobes in the lower lobes.

"Lung cancer?" Xu Yourong frowned, her knowledge of lung cancer was far inferior to that of other emergency doctors, let alone Rachel, an expert in oncology. After thinking about it for a while, she decided to call the doctors in the respiratory medicine department for a consultation.

Wang Yin, the attending doctor of the Department of Respiratory Medicine, glanced at the X-ray and shook his head to deny the possibility of lung cancer. "The boundaries are clear, not like lung cancer. This is a severe pneumonia......" he suddenly turned his head and asked, "What is the patient's oxygen saturation?

"The body temperature is 37.4 ° C, and the blood oxygen saturation is 92%. Xu Yourong replied, "I am already inhaling pure oxygen for patients." ”

"Severe pneumonia is the most likely. Wang Yin handed back the X-ray, "I recommend taking anti-infection treatment first, and then doing a sputum culture to confirm the type of infection." ”

On the advice of the specialist, Xu Yourong naturally did not have any opinions. As soon as Wang Yin left, Xu Yourong, who got the blood routine examination report, noticed something unusual in the report. "White blood cells are low, thrombocytopenia is low, neutrophils are low. ”

"Cefepime hydrochloride, 1g, with 200ml of 0.9% saline intravenously. Then a bottle of imipenem cilastatin sodium, 1000mg, with 200ml of 0.9% saline intravenous infusion......" she paused and emphasized, "Imipenem is up, pay attention to the injection speed." ”

Cefepime hydrochloride is a fourth-generation cephalosporin antibiotic that is highly effective against neutropenic infections. Imipenem is a miracle drug for the treatment of severe lower respiratory tract infections with a clinical effective rate of 93.0%. Both drugs are clinically "cautious" controlled antibiotics. In order to maximize the effectiveness of antibiotics and reduce the chance of the emergence of drug-resistant bacteria, doctors rarely prescribe these two drugs to patients. And Xu Yourong's behavior at this time was really a last resort.

Anonymous's symptoms are very severe, but if you have to wait for the results of the sputum culture to come out, I am afraid that it will be several days. With her current oxygen saturation of 92%, if the infection is not controlled as soon as possible and the progression of pneumonia is stopped, she may have to rely on a ventilator in a few hours.

Xu Yourong looked at the inspection report in her hand, although she had made the right response, she still felt a little unsteady in her heart. The severity of the patient's condition, combined with a not-so-high body temperature, gave her a vague feeling that something was not quite right.

Could it be because the patient's immunity is very poor, so he can't make an obvious immune response? Xu Yourong pondered for a moment and decided to add another bottle of gamma globulin injection to Anonymous. This combination of human blood preparation and antibiotics can effectively improve the effectiveness of antibiotics in the treatment of serious bacterial infections.

After making the arrangements, Xu Yourong breathed a sigh of relief, and it was indeed a little tiring to deal with emergency patients alone. 8)