I can see the status bar

Chapter 1124 The Special Patient

Sun Li'en led the team to Beihu Hospital of Yunhe City, where he and the medical team started their first rounds.

The weather is not too good this morning, the sky of Yunhe is gloomy.Halfway through the bus, it even started to rain lightly.

Yunhe's recent weather is a typical southern winter, cloudy, humid and cold.The original cold-proof equipment of the doctors in the medical team seemed a little thin in this weather. After all, the weather in Ningyuan was far from being so humid.Although there is no heating, but if you wear thicker clothes, Ningyuan's winter is still passable.

And the weather in Yunhe... In addition to the coldness brought by the humidity, the deserted feeling that no passerby on the street can see is probably an important factor that causes everyone to feel the cold.

The shuttle bus drove quickly on the street, and after about 10 minutes, the doctors from the Comprehensive Diagnostic Center of Ningyuan No. [-] Hospital arrived at Beihu Hospital of Yunhe City.

Song Wen had already been guarding the gate. In the cold wind and rain, she and two other people in white coats stood under the canopy of the gate, with rain stains on their trouser legs.

Sun Lien got out of the car with his colleagues, and everyone formed a loose formation at the door.Bruno stood out among the crowd like a chicken, standing half a head taller than the other doctors.Yuan Ping'an and Ma Yongfang stood in the middle of the line - the dark circles on their faces looked like they had just been beaten.As for Chen Tianyang's relatively special status, he walked directly to Song Wen's side and did not "arrange" with everyone.

"Thank you for your hard work." Song Wen nodded towards the "elite soldiers and strong generals" brought out by himself, "I think Director Sun has already told you about the mission this time."

Everyone nodded together, they already had a rough mental preparation for today's work.

"At present, the number of patients transferred from the community will not be too many, and the patients who can be handled by the community hospital will not be transferred." Song Wen emphasized, "There are only three types of patients who can be sent to us, critically ill patients , those who need surgical treatment as soon as possible, and those who are not sure what the problem is in the community hospital.”

"Our fourth hospital is a large emergency center, and I have only one request for you—to polish the brand of our fourth hospital!" Song Wen raised his voice and said, "The eight of you have to support a third-level hospital for treatment. However, don’t be brave, and don’t think that this patient has to be figured out in your hands. Medicine is a discipline with a detailed division of labor, and you can’t conquer the world. Admitting counsel when it’s time to admit counseling is the correct science manner."

Song Wen's words touched everyone's heart.After all, among the doctors present, there was Chen Tianyang as a general surgeon and digestive surgeon, Wang Guonan who was also a general surgeon, Ma Yongfang from the endocrinology department, and Chen Xuerong from the cardiology department.And Xu Yourong and Yuan Ping'an are both born in the gods, Zhou Ce is a nephrologist, and Bruen is a talent in emergency and critical care medicine.

There is also Sun Lien who is hanging up.

Including Sun Lien, there are nine doctors in total, who can cover a considerable part of the treatment content.But at the same time, they also have strong limitations - if you encounter a patient with aortic dissection or acute leukemia, Sun Lien and Brunn may be able to help them with some emergency treatment, but if you really want treatment, you still have to ask a specialist to take over .

"The first batch of patients will arrive at the hospital in 10 minutes. Next, I would like to ask Director Wu, who is in charge of outpatient work, to introduce the specific situation." Song Wen finished his short speech and signaled the doctor next to him in a white coat to start. explain.

"The diagnostic methods we can provide to doctors are as follows..." Director Wu started his introduction very quickly. He didn't even have time to introduce himself, and then introduced to everyone what the current laboratory can provide Check item.

According to Director Wu, the laboratory department of Beihu Hospital is under a lot of pressure now.Almost all the staff have devoted themselves to the detection of new coronavirus PCR.They not only need to undertake the task of PCR testing of patients in this hospital, but also undertake the task of testing samples sent by three surrounding hospitals.

Under this pressure, the inspection items that the Laboratory Department of Beihu Hospital can provide in a timely manner are mainly concentrated on the automatic inspection items of the machine.Including blood routine, five items of infectious diseases, urine test, biochemical analysis, coagulation time, microbial drug susceptibility analysis, etc.

In addition, the Department of Imaging and Nuclear Medicine of Beihu Hospital can also provide a CT and a 1.5T MRI for imaging examinations, and the Department of Ultrasound can provide a B-ultrasound for examination.

"The current testing content we can provide is these..." Director Wu seemed very dissatisfied with this situation, he sighed and said, "According to the requirements of relevant departments, our current chest pain center and stroke center are still open, but These two centers can only handle two patients at the same time. Due to the particularity of chest pain and stroke, we cannot judge how many patients will be sent in the future. There is no way to notify such patients in advance. Please pay more attention. Heart stent surgery can be performed in the hospital now, but heart bypass surgery cannot be performed temporarily. Similarly, we have equipment to perform stent thrombectomy for ischemic stroke caused by internal carotid artery or proximal middle cerebral artery occlusion, but we are not able to preside over the operation The doctor. There are conditions for using thrombolytic drugs for thrombolytic therapy. But hemorrhagic stroke..."

Sun Lien said suddenly, "There are two neurosurgeons in our team, they can perform emergency operations for hemorrhagic stroke, Director Wu, can you provide other members of the surgical team?"

Director Wu thought for a while and said, "It's no problem to assemble a team. As long as you inform, we can complete the team assembly within 10 minutes. But the second team may be more difficult... mainly because there is no suitable first aid at present."

In surgery, the responsibility of the first assistant is very important.Doctors in this position need to complete a lot of practical work for the chief surgeon, including skin incision, free tissue to expose the field of vision, create suitable conditions for surgery, and so on.In terms of workload alone, the first assistant may be harder than the chief surgeon.

The neurosurgery operation not only requires good cooperation, but also needs a helper to minimize the damage to the nervous system when completing the work.Different surgeons have different operating habits, and the requirements for the field of view are also somewhat different.Therefore, the first assistant in the surgical operation is generally a doctor who has been partnering with the chief surgeon for a long time.In most cases, the first assistant was promoted from the second assistant who worked with the surgeon on many surgeries.

To allow Xu Yourong and Yuan Pingan to complete the operation on a patient with hemorrhagic stroke without any help, it is as difficult as asking a straight man who is about the same size as Brunn to suddenly put on nine centimeter high heels and complete the operation The 4×100 meter relay is just as difficult.

However, after all, Beihu Hospital is an old tertiary hospital, and the level of doctors in the hospital is quite good.Among the neurosurgeons on leave today, there is a senior attending physician.Although he is a senior doctor, he is not yet qualified to perform intracranial vascular embolization and intracranial malformation vascular resection due to manpower and rotation problems in the top three hospitals.

Although he is not qualified to perform surgery, there is no problem as a qualified first aid.

But if there are two such surgeries at the same time, then only one additional supernatural doctor who can act as a first aid can only be transferred from the red zone.This takes at least 10 minutes or more.

If there are three... then it will take at least four and ten minutes, so that the only deputy neurosurgery doctor currently on duty in the hospital, the first assistant, the surgical nurse and the anesthesiologist can be matched.

"Why did it take so long?" Sun Li'en asked with a frown, "There is only a deputy director of God's Department in the courtyard now?"

"We also support other second-level hospitals to carry out the task of treating patients with pneumonia caused by the new coronavirus." Director Wu sighed, "All the doctors in the whole hospital are busy. Many of the doctors either work in the red zone of the hospital, or go to the surrounding second-level hospitals to support them. There are really not enough manpower now."

This is a question that Sun Lien hadn't thought of before.He nodded, "That's it, let's get into the post as soon as possible, and then get familiar with the environment and start working."

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After changing into the protective clothing, Sun Lien sat in an unfamiliar consulting room, feeling a little strange.

Although it is not the first time to conduct rounds, the purpose of this time is completely different from before. The patients who came to the outpatient clinic this time are all patients who have been triaged by community hospitals and have a very low risk of infection with the new coronavirus.They come to the hospital because they have other diseases that need treatment.

This feeling is suddenly different!
Sun Li'en sighed, and then began to pray silently, hoping that his face would not be too dark.It’s okay to have some rare diseases, just don’t come to a rare disease patient with a new type of coronavirus.

"Dong dong dong", just as Sun Lien finished his prayer, someone knocked on the door of his consulting room three times, and with three muffled thuds, a middle-aged man's voice came in, "Doctor, can I come in? "

"Please come in." Sun Li'en said, while he invited the patient in, he paid full attention to the reminder on the status bar.At present, the warnings of "high risk of pathogenicity" and "high risk of transmission" have not popped up in the status column, which shows that there is no new type of coronavirus in this second clinic.

If the warning jumps as soon as the door is opened, it means that the patient is likely to be carrying or infected with the new coronavirus.If this is the case, Sun Li'en will definitely ask for leave tomorrow, and then find a famous temple in Yunhe - even if he doesn't open the door, he will get something like "Is there any reason!" .

Fortunately, the status bar is quite face-saving.The man named "Ding Huiguo" walked into the consulting room.He was wearing a medical mask, a cold mask, and clear goggles over his face.Ding Huiguo nodded to Sun Lien, then walked slowly to Sun Lien and sat down.

"Doctor, I have Crohn's disease." Ding Huiguo, 42, introduced himself to Sun Lien.

Three years ago, Ding Huiguo began to suffer from recurrent diarrhea and had to defecate three or four times a day.But because there were no symptoms such as abdominal pain, bloody stools, fever or night sweats, he didn't take it seriously.

On the National Day two years ago, Ding Huiguo's symptoms suddenly started to worsen. In addition to repeated fever, he also suffered from knee and ankle pain.Although the fever can subside on its own, the joint pain still made him decide to go to the hospital for a look.

In a second-class hospital near his home, the doctor conducted a T-cell spot test for tuberculosis infection and a skin test for tuberculin pure protein derivatives, but both tests were negative.The colonoscopy showed that he had "multiple ulcers of the colon", and the biopsy pathology through the colonoscopy showed that the sample had a "chronic inflammatory reaction".

Such an inflammatory reaction aroused Ding Huiguo's own vigilance.He has seen the statement that "repeated inflammatory trauma can easily lead to tumors" on many "health care" public accounts, and after learning that his enteritis may have lasted for a long time, he immediately found a company that can perform PET-CT A private imaging institution, and then prescribed a PET-CT examination for himself.

The test results showed that he had no tumor risk.However, the intestinal inflammation ranges widely—the ileocecal region, the proximal ascending colon, the splenic flexure, the descending colon, and the sigmoid colon have thickened intestinal walls and increased metabolism, and inflammatory lesions are considered.

This diagnosis was placed on the table of the gastroenterologist, and together with the previous colonoscopy and biopsy results, Ding Huiguo was officially diagnosed with Crohn's disease.

Crohn's disease is a non-specific inflammatory disease with the digestive tract as the pathogenesis area.The etiology of this disease is not yet fully understood, but the medical community generally believes that it should be caused by the interaction of various factors including environmental factors, genetic factors, infection and intestinal flora imbalance, and immune factors.

Environmental factors act on genetically susceptible individuals. With the participation of intestinal flora, the intestinal tract initiates an abnormal immune response and eventually causes immune damage and validation.However, due to the patient's immune regulation disorder or the continuous stimulation of specific antigens, this immune inflammatory response is excessive and difficult to limit.

In other words, it can be one of the worst things that can happen to a person after a bout of diarrhea.

Crohn's disease is incurable and has a tendency to recur for life.

After the diagnosis, the local hospital prescribed Ding Huiguo a treatment plan of oral prednisone 50mg/d, and the doctor ordered Ding Huiguo to start reducing the dose regularly after the symptoms were relieved.A follow-up colonoscopy three months later showed that his colon ulcer had healed.But when the prednisone was reduced to 20mg/d, Ding Huiguo had diarrhea again.

Two months after the onset of diarrhea symptoms, the doctor gave Ding Huiguo infliximab treatment for a total of four times. Subsequent reexamination showed that the colon ulcer had healed.

And two months after the reexamination, Ding Huiguo had a fever again.This time, the CT examination indicated that there were strips in the apical segment of the right upper lobe and the outer basal segment of the lower lobe, and there were multiple small nodules in the left lung.

Based on the positive results of the T cell spot test, the local hospital judged that Ding Huiguo was infected with tuberculosis.He was discontinued from infliximab and switched to isoniazid, rifampicin, pyrazinamide, and ethambutol.Subsequently, his fever symptoms eased.Periodic follow-up colonoscopy six months later showed that his intestinal ulcer had healed.

Nine months later, in December last year, Ding Huiguo's colonoscopy showed new ulcers in his descending colon, and the doctor stopped his anti-tuberculosis treatment.

According to the original plan, he should have another colonoscopy in January this year, and judge whether he needs to undergo monoclonal antibody or hormone therapy again.However, due to the epidemic, this inspection was postponed for more than a month.It wasn't until two weeks ago that he started having diarrhea again.This time the diarrhea was accompanied by blood in the stool and joint pain.

Long-term treatment was ineffective, which made Ding Huiguo very painful.And just when he was about to prescribe some prednisone oral tablets through the community hospital, the local community hospital discovered Ding Huiguo's Crohn's disease history through the networked medical record system.Community doctors considered immunotherapy and possible potential risks of tuberculosis infection, so they refused the request to prescribe the drug, and decided to refer Ding Huiguo as a high-priority referral object, and let him go to the hospital for formal treatment as soon as possible.

(End of this chapter)