Conan: The Mechanic

In the medicine cabinet beside D, a yellow needle was taken out by the doctor who ran in. "Amiodarone is ready for a quick intravenous push! 300 mg!" With that said, he pulled up a tube with a yellow plastic connector on D's bed with the hand that didn't take the needle tube - it was the indwelling needle on D's body the end - and quickly push the yellow liquid into it.

Amiodarone, the most common and widely used antiarrhythmic drug, is known for its versatility, and despite its considerable side effects, in the current situation, only such a crude drug can be used for drug cardioversion.

But this didn't seem to have the desired effect, because the original "ding bell ding bell" warning sound of the ECG monitor on the side quickly turned into a more harsh beep and a high-frequency "beep beep". reverberation, and the dense sinusoidal waveform that was still regular has become an extremely dense irregular sawtooth.

Ventricular fibrillation, compared with the previous state of ventricular tachycardia where the myocardium was only beating continuously at an extremely fast speed, the ventricular muscle at this time has completely entered the final state of madness, and there is no rhythmic joint effect, leaving only the various Parts of the myocardium act erratically - in such a situation, the heart is completely unable to perform its normal functions.

After "V-fib! (ventricular fibrillation briefly reported the new situation, the doctor threw the injected amiodarone needle far away, grabbed the conductive glue of the defibrillator from the plate above the medicine cabinet, and twisted it. After opening the lid, it was sprayed **** an electrode plate. Then, he grabbed the two electrode pads with both hands, rubbed each other a few times to make the conductive glue cover the two electrode pads, and then stuck the two electrode pads under D's always exposed right clavicle and left The position under the breast - the positive and lateral electrode placement method "200 joules!"

With the sudden disappearance of the gradually harsh charging sound, D's body bounced like this, and then fell back to the ground heavily - the principle of defibrillation is to release a strong current of thousands of volts to the heart through the electrode pads, making Under such high-intensity stimulation, the ventricular myocardium of each place rapidly depolarizes and enters a short refractory period of complete tranquility. Then, when ventricular muscle activity resumes everywhere, the most automatic pacemaker (usually the sinoatrial node) is likely to resume its task of controlling the rhythm of the heart.

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Author: In short, the concept of ventricular fibrillation and defibrillation can be expressed by the following example.

Normal beat: A group of students read the text aloud in a normal chorus

VT: I don't know why, but everyone's reading speed is suddenly very fast, but it is still synchronized

VF: Everyone was completely confused, everyone was reading different paragraphs at different speeds, the scene was extremely chaotic

Defibrillation: The teacher angrily tapped the blackboard with a teaching stick, and everyone was so frightened that they hurriedly shut their mouths.

Successful defibrillation: After everyone was quiet, the Chinese class representative or the monitor suddenly began to re-read the text in a low voice, and other students would gradually follow the class representative and re-read the text in a normal state.

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"Ineffective!" After confirming that the heart rate had not recovered, the doctor immediately reported and restarted charging.

"Second time." The second doctor had already rushed in, and while saying this, he also ran to the medicine cabinet and grabbed an epinephrine.

"Bang——" The second electric shock also ended in failure.

"Turn him over!" The doctor yelled so loudly, and the second doctor responded immediately and pushed D to the side lying position, exposing his back to the electrode pads.

In addition to the anterolateral position previously used, there is a pattern of pad placement known as the anteroposterior position: the paddles under the left breast remain the same, while the paddles under the right clavicle are moved to a posterior-right position . Generally speaking, the anteroposterior placement method and the anterior lateral placement method have a complementary relationship. When one is ineffective, it may be surprising to switch to the other. And the reason why another doctor has to turn D over is precisely because only in this way can anterior and posterior shocks be performed

"Bang!" Disappointingly, the third electric shock still failed to change the state of ventricular fibrillation, and before they started the fourth attempt, the frantic line of ventricular fibrillation quieted down on its own.

Of course, this does not represent the almost impossible self-healing of terminal ventricular fibrillation, but rather like a dancing plague, death after crazy dancing.

The sound like a death knell stopped the other doctors who were already coming here, and the second doctor who pushed the adrenaline in quickly also showed a sad look, leaving only the first doctor. The doctor is still doing the final cardiopulmonary compressions.

Time of death, 22:27.

…………

When the patient dies, many tests are performed, and the final test results appear in front of others.

[Primary amebic meningitis], acute meningitis caused by the free-living amebic subtype Naegleria - what ultimately gave this result was a deep biopsy directly in the white matter deeper in the brain, under a microscope Amoebae in trophozoite form were observed.

"So, why are we here this time?" Chiyu, who put on protective clothing again, was clearly still in a daze after being told the cause of D's death.

"The ability of amoeba to spread is not very strong. Generally speaking, it is necessary to let water enter the nasal cavity at least." Gregory said this while turning on the light. "I can understand if the family was infected, but D didn't come into contact with many water sources. How did he get infected?"

"Could it be the time to take water samples? Like a faucet..."

"He shouldn't make such a mistake..." When Gregory said this, he suddenly walked in the direction of the guest guard. "Except if you want to wash your hands after going to the toilet. But generally speaking, it's very difficult to transmit amoeba from living water in an occupied room, but I think we can test it."

Although in humans, amoebas are difficult to detect - their cerebrospinal fluid culture results are difficult to succeed. But to detect traces of amoeba from water, all it takes is a light microscope, a few minutes and a sufficiently experienced observer.

But after such a round of inspections, they couldn't find any traces of amoeba in the water in the sink taps of the main and guest bathrooms. If the amoeba could not be observed when the tap was not turned on for several days, it is even less likely that the amoeba was present when the water was used a few days ago.

Under such circumstances, both Gregory and Chiba thought of the last place that was equally likely to be the answer to everything.

……

"I remember we should take the water sample back, right?" Qianyu said, standing next to Gregory, looking at the arrangement in the flower room. "Did the inspection find nothing?"

"No, and no amoeba has been detected even now." Gregory was also staring at the set in the flower room~www.NovelMTL.com~ If I didn't really think of other possibilities, I wouldn't bring it with me. You are back here again. "

"Yeah, we are really--" Chiyu's words suddenly stopped, and his eyes were focused on the water pipe on the ceiling.

The analysis function of the auxiliary unit told him that the conservatory has two independent piping systems, and the water samples they collected here before came from the sink of the conservatory. In contrast, the sprinkler system on the ceiling of the greenhouse is connected to another set of pipes.

"The pipes above, we don't seem to be testing the pipes of the sprinkler system used for watering - it's not a tap water system."

"What..." Gregory looked up like he was just waking up from a dream.

"Looks like we've found the answer?" Chiba said as she looked at the end of the pipe—a hole leading to the top of the metal plate ceiling.

This is the top floor of the whole building, if the roof drain is connected to the hidden cistern that belongs to this house hidden above the ceiling... I am afraid that anyone who is not familiar with this building will not be able to find this. , it is even more impossible to check whether there are a large number of amoebas in it.

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In fact, the treatment plan for primary amebic meningitis is also similar, with several drugs led by amphotericin B. The reason why D died after taking the medicine is because the treatment of the disease itself is relatively difficult, and even if the medicine is taken, it cannot be guaranteed.

Also, the reason why D deteriorates faster is because both ABCs have Legionnaires' disease, and Legionnaires' disease stimulates the work of the immune system more strongly and delays the rampant speed of the amoeba. D's immune system is not working well, which is why the brain biopsy was negative for signs of infection.