I can see the status bar

Chapter 1145 pondering
After two consecutive days of training, the doctors and nurses of the fourth batch of medical teams had a comprehensive understanding of Yunhe's situation for the first time.

In addition to the professional training that is absolutely indispensable, the content that everyone is most concerned about is the patient's condition and treatment plan.Everyone came to Yunhe to treat diseases and save lives, but most of the doctors and nurses in the medical team had no experience in treating confirmed patients.

What symptoms will these patients show, what plans need to be used to deal with them, which traditional intensive care experience can be used, and which experiences need to be adjusted... These questions need to be answered by the doctors of the previous medical team.

After Sun Lien finished the training, Zhou Jun also came here to ask a few questions—these questions were mainly related to ventilator settings and immunotherapy.

"Understood, in fact, it is the same as our usual treatment, try to avoid plasma exchange after medication?" Zhou Jun nodded, and wrote down the last few strokes in his notebook.

Seeing Zhou Jun's serious look, Sun Li'en suddenly felt a little unreal - a few years ago, he was still a little guipei who didn't understand anything running behind Zhou Jun's ass.But now, on the front line of Yunhe's fight against the epidemic, Zhou Jun actually had to ask himself about his professional knowledge first.

"Do you feel a little unaccustomed?" Zhou Jun looked at Sun Lien's gradually out-of-focus eyes and asked with a smile, "Aren't you used to giving me lectures?"

"Yes." Sun Li'en replied honestly, "I might not be able to get used to it in a while."

"You, everything else is fine. It's just that I'm still not clear about my current identity." Zhou Jun closed his notebook and said, "How many years have you been trained? We are not in the same department now—you are a diagnostician." The director of the department, I am the deputy director of the emergency department. I have a professional problem and I don’t understand it. Isn’t it normal to come to you for advice?”

"That's the truth." Sun Li'en said helplessly, "But if I can follow the truth in everything I do, wouldn't I be a saint?"

The unity of knowledge and action is the highest requirement of a gentleman for himself.A further step is to "understand the truth and be able to do the right thing without hesitation."

The difficulty lies in this "no hesitation".So Sun Lien said this.

"I think you are not far from a saint." Zhou Jun smiled, "Since the outbreak just started this time, you asked Xiao Shen to make the test kit, right? Dean Liu told me several times that you did it This kit is of great significance. The subsequent treatment plan and refined management, accurate adjustment of the balance of intake and output...these plans are very useful."

"These are all mature treatment plans, and I'm just picking on the wisdom of others." Sun Lien is not proud of these "achievements" of his own.On the contrary, he has always felt that his own treatment plans are not much different from other people's ideas.

Even for triple therapy, Sun Lien used existing drugs and Dr. Pascal's expertise.He really didn't feel that he had done anything extraordinary.

"Before the ventilator was invented, doctors used iron lungs to assist patients with polio with mechanical ventilation." Zhou Jun shrugged his shoulders and said, "Combined endotracheal intubation is a later thing, but you always It cannot be said that Mr. Bennett's improvement is meaningless. In fact, it is his "picking up the tooth and wisdom" that makes the iron lung change from a useless giant machine to a tool that saves patients' lives."

Zhou Jun said earnestly to Sun Li'en, "Your biggest problem now is that you don't realize that you are a director. What do we third-line doctors do? It is to back up the first-line and second-line doctors. It is to cover the bottom line. , is to lead this department to keep up with the trend and achievements of medical and technological research and development, and to ensure that patients can receive the best and most advanced treatment."

Sun Li'en was a little confused by this series of words, but he still roughly understood what Zhou Jun meant.

"You have to have some confidence in yourself. Of course, I don't mean to make you inflated and feel that 'I am the best in the world'." Zhou Jun laughed, "But you have to understand that a director full of confidence and a director who is not at all The director who is sure what he is doing is completely two different species. The doctors and nurses who worked with you in the comprehensive diagnostic center are used to it and it doesn’t matter. Those medical staff who have been fighting with you in the North Fifth District for more than a month Probably already able to accept your appearance. But the newcomer has to go through a process of adaptation."

"Then...then I try to be a little more confident?" Sun Lien asked very unconfidently, "Is this okay for the head office?"

"A confident director won't say, 'Is this the head office?'" Zhou Jun shook his head, "We like to say, 'That's all right.'"

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Ordinary patients in North Fifth District basically "come and go".After two or three days of hospitalization, their symptoms improved dramatically.After the upper respiratory symptoms disappear quickly and their body temperature returns to stable, these ordinary patients can leave the designated hospital directly, and then continue to receive isolation treatment in the shelter hospital.

But not all patients have such good "luck".With the same treatment method, most patients can improve quickly, but some people's symptoms just refuse to disappear, and even progress.

This patient named Yang Yifei is currently having such a problem - the 29-year-old was sent to North Fifth District for treatment as an ordinary patient, but after three days of treatment, his symptoms not only did not disappear, but even worsened .

"Judging from the CT images, he has ground-glass opacities in both lungs, and the extent of the lesion has progressed." Director Lu Zhimin specifically mentioned Yang Yifei's situation to Sun Lien when he took over the shift, "His inflammatory indicators are relatively high. , but it has not yet reached the level that requires the use of tocilizumab. Although the oxygen saturation is not ideal, it is still acceptable under the condition of oxygen inhalation and rest."

"The question is, what caused his symptoms to gradually worsen." Sun Lien frowned and looked through Yang Yifei's medical records, and then asked, "He said he didn't have any other underlying diseases?"

"I deny it, and it was not mentioned in his medical records." Lu Zhimin shook his head and said, "We have also considered the direction of underlying diseases. At least for now, it seems that his immune level is very normal. There is no specific antibody. Positive, and no other questionable direction."

Sun Lien was about to say "I don't have any particularly good ideas", but Zhou Jun's earnest teaching suddenly sounded in his heart, and Sun Lien immediately changed his expression.

"I'll see what's going on with this patient." He closed the case and said seriously, "If necessary, I'll ask for a consultation."

As soon as this remark came out, the others immediately focused on the case in Sun Lien's hands.Lu Zhimin was the most "intense" about this, "Do you think he has any other problems? Rare diseases?"

Sun Lien's ability to deal with rare diseases and "provoke" rare diseases has become the most famous urban legend in Yunhe City Infectious Disease Hospital.The doctors in the medical team have long reached a consensus on Sun Lien's ability - as long as Sun Lien treats patients seriously, they will basically be unable to get rid of the result of a rare disease in the end.

Exacerbation of symptoms in younger patients is of course an uncommon occurrence.But Director Sun Lien suddenly took Yang Yifei's question so seriously... Does this mean that Director Sun's nose has smelled a little suspicious smell of rare diseases?
Sun Li'en was a little confused by everyone's reaction, but the director's personality of "a well-thought-out plan" cannot be defeated.He bite the bullet and said, "There is no evidence yet, and there are not many clues. Let's not preconceive it and rule out any possibility."

Lu Zhimin exchanged glances with several deputy directors beside him, and then nodded thoughtfully together.It seems that Director Sun has confirmed that Yang Yifei has some rare problems, but there is no strong evidence yet.

"After that, Dr. Sun will have to worry more." Lu Zhimin said seriously, "If you need anything, just say it."

Sun Li'en sent Lu Zhimin and his team members away with a smile.Then reopened the case and started reading.Although he had met Yang Yifei before, the status bar did not give any hints other than "new coronavirus infection".In his opinion, the exacerbation of Yang Yifei's condition is likely to be the result of differences in "personal physique".It's not to remind him of any other problems.

Compared with Yang Yifei's problem, the more noteworthy patient at present is the old man who grabbed the second bed.

Tian Kang, 61, is a critically ill patient who needs the attention of doctors.He is simply the opposite of Yang Yifei. Yang Yifei has no underlying disease, and his symptoms have progressed and aggravated inexplicably.However, Tian Kang, who had failed kidney transplantation and suffered from advanced Hodgkin's lymphoma, showed an inexplicable improvement in his symptoms.

As an elderly male patient who relies on dialysis to maintain his life and has multiple metastases of systemic Hodgkin's lymphoma, Tian Kang's symptoms rapidly worsened after being infected with the new coronavirus.He has severe dyspnea and wheezing and is currently on life support.

Today is the seventh day of his hospitalization. One week after he was admitted to the hospital, Tian Kang's lung lesions began to shrink gradually, and a chest CT showed a very strange situation.

Lymph nodes in his lungs, swollen with Hodgkin's lymphoma, began to shrink.

Since the level of inflammatory indicators such as interleukin-6 is not very high, Tian Kang did not receive the triple therapy that is still in the experimental stage.At the same time, as a patient with renal failure and an end-stage malignant tumor, he is also not eligible for inclusion.

Sun Lien and Lu Zhimin's current life support plan for Tian Kang is CRRT continuous blood purification combined with mechanical ventilation.As for the antiviral solution, we chose nebulized interferon inhalation, convalescent serum and continuous administration of Arbidol.At the same time, Dr. Fu also prescribed traditional Chinese medicine decoction for Tian Kang to take every day.

On the whole, Tian Kang's treatment plan is more inclined to the basic and conservative plan.His physical foundation is too poor, and in the case of kidney failure, all medications must consider the metabolic pathway and clearance rate.The malignant tumor caused his body to consume extremely fast, and the nutritional support currently given to him by the treatment team has reached the level of 4000 calories per day.

When Tian Kang was first admitted to the hospital, Sun Lien, Lu Zhimin and Li Chengping all thought that he might not be able to resist the virus.A broken boat that was leaking everywhere was hit by a torpedo. It was impossible for this boat to continue to float on the water!

But the fact is that Tian Kang's broken ship not only did not sink to the depths of the ocean, but after being hit by a torpedo, the speed of the hull leaking actually slowed down.

It's really weird.

In order to ensure that the patient's initial diagnosis was correct, after confirming that the status column gave a prompt of "Hodgkin's lymphoma", Sun Li'en still found the patient's previously diagnosed PET report, as well as a needle biopsy of Tian Kang's lymph from an outside hospital. subsequent reports.

The diagnosis was correct, he did have a malignancy.

A patient with a malignant tumor, not to mention kidney failure, and infected with the new coronavirus... How did he get better?

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"I don't think it's meaningful to think about the shrinkage of Tian Kang's lymph nodes now." Sun Lien took this issue to the group consultation for discussion, and Zhou Ce first discussed whether the discussion was necessary.

"The purpose of all our treatment now is to make him recover from the new coronavirus infection as soon as possible." Both Xu Yourong and Wang Guonan expressed the same idea, "Just because the current chest CT shows that the lymph nodes have shrunk, it cannot prove that Hodge The gold lymphoma has improved. Even if it has improved, it has nothing to do with our treatment, let alone our purpose."

Sun Li'en said helplessly, "I just can't figure it out—it can't be the plasma of convalescents or Abidol that has anti-tumor effects, right?"

"Don't think about things you can't figure out." Ma Yongfang once again used the unclear mechanism of metformin as evidence, "As long as it is useful, it will be fine."

The discussion quickly shifted to Yang Yifei. When everyone was discussing, Bernard suddenly walked up to Sun Lien and said, "Tian Kang's case, I don't think... it is not surprising that the tumor shrinks."

"Why?" Sun Lien glanced at Dr. Bernard with great interest. He knew that Bernard and Rachel were colleagues before, and both of them were experts in oncology treatment and research.But he didn't expect that Bernard could say to himself, "It's not surprising that the tumor shrinks."

In addition to chemotherapy and radiotherapy, doctors in the oncology department only use targeted drugs or simply ask for help from surgery?

"Here is a story." In order not to disturb the discussion of other team members, Bernard deliberately lowered his voice and told a story to Sun Li'en.

In the 20s, tumors were as incurable as they are now.The only difference is that doctors at that time had few tools to slow the progression of tumors. In 1884, radical mastectomy was born, and in 1903, the original radiation therapy was introduced into the tumor treatment process.But these methods are not only extremely traumatic, but also a mystery as to how effective they can be.

Some patients do well after receiving treatment, while others die quickly after treatment.

Treating tumors has always been the direction that doctors are looking for.And a New York doctor got a special "inspiration" during a consultation.

One of his patients had a sarcoma that progressed rapidly.What is even more unfortunate is that this patient suffered from erysipelas at the back of the neck soon after the cancer was diagnosed.

Erysipelas is an acute skin infection caused by a common beta-hemolytic streptococcus, and in the 20s, when sulfonamide was still 12 years away from being synthesized by people, acute skin infections and tumors The result is the same.The difference between the two is nothing more than that erysipelas kills faster, while tumors are much slower.

However, this "unlucky" patient seemed to have been blessed by God. When she was checked again after she survived the acute infection, the tumor had completely disappeared.

"The doctor mistakenly believed that erysipelas could treat tumors, and he 'vaccinated' many tumor patients with beta-hemolytic streptococcus..." Bernard blinked and said, "I think...Tian Kang's situation may be This is consistent with this patient who suffered from erysipelas. The improvement of their tumors was not a direct consequence of the infection, but an additional consequence of the immune response triggered by the infection."

　I'm really sorry for posting the anti-theft chapter, I'll give you 500 more characters~
　　
　
(End of this chapter)