On February 21, the second hospital of Shandong University supported the members of Hubei national medical team to intubate the patients to the second hospital of Shandong University
Endotracheal intubation and ventilator are only short-term maintenance. The key is to find a way to successfully remove the machine and the ventilator, so that patients can really get rid of life danger
The treatment of every serious case is an exciting battle.
In this place closest to death, the medical staff try their best to improve the accuracy and effectiveness of clinical treatment, and only try their best to snatch the severe patients back from the hands of the God of death. The story of their novel coronavirus pneumonia is worth every one of us.
Transit life and death line
On February 20, the experience of transferring patients made Kang Yan, who was used to life and death, feel thrilling.
Kang Yan is director of the Department of critical medicine, West China Hospital, Sichuan University. On February 7, he led the third group of Western China medical aid team of 130 people to enter the East Hospital of Wuhan University Peoples Hospital, and was ordered to take over the two critical disease areas here, responsible for the treatment of critical patients with a total of 80 beds.
At 1:18 p.m., Kangyan reply: 23 ward is acceptable.
Although determined to receive patients, the difficulties are obvious - ward 16 and ward 23 are in the same building, but ward 16 is on the 7th floor, ward 23 is on the 14th floor, and the transfer time is about 15 minutes. This 15 minute route is a life and death line for the transport team and the patients. The patients may have decreased oxygenation and cardiac arrest at any time. Kang Yan said.
In order to reduce the transport risk of patients as much as possible, Kang Yan personally ordered the attending doctor Lai Wei, respiratory therapist Wang Peng and nurse Zeng Peng to form an emergency transport team.
The emergency transport team immediately defined the division of work: Lai Wei was responsible for the overall condition and transport risk assessment, Wang Peng was responsible for the adjustment of respiratory treatment scheme, Zeng Peng assisted in transport and ensured the smooth flow of venous access.
After a rigorous transport rehearsal, the emergency transport team arrived at the 16 ward with all the rescue drugs and equipment that may be needed. At this time, they found that the patients condition was already very not optimistic: after the mask was given oxygen inhalation (10L / min, maximum transport support), the patients oxygenation was still unable to maintain, the oxygen saturation dropped to 40% - 50%, less than half of the normal value of 95% - 100%, and the patient might have a sudden cardiac arrest at any time.
After about 1 hour, the patients condition gradually stabilized.
The emergency group decided to transfer the goods immediately. A paramedic ran to the elevator first and locked it on the 7th floor. Later, the group slowly and smoothly pushed the bed carrying the patient out of the ward, with the monitor attached to the patient, and the ventilator, oxygen cylinder and other emergency supplies needed. Because the patient has a lot of instruments, we cant walk fast, we can only walk slowly. Lai Wei said.
After entering the elevator, the group keeps a close eye on the working state of the ventilator and the vital signs of the monitor. Once the patients condition changes or there is a mechanical failure during the transfer, it is very troublesome because the rescue equipment and drugs carried during the transfer are not enough, Lai Wei said
With the help of 3 doctors, 1 respiratory therapist and 3 nurses, the anesthesiologist escorted the group for nearly 20 minutes and finally successfully crossed the life and death line.
In the early morning of February 22, Xie Kun, who was on duty, received a phone call: Hello, I am in e3-5 ward, and 12 patients need emergency endotracheal intubation. Male patient, 68 years old, non-invasive ventilator treatment effect is not ideal, oxygen saturation progressive decline
Xie Kun quickly replied, OK, Ill be right there.
Xie Kun, who hung up, glanced at his cell phone at 2:09.
Xie Kun is a deputy chief physician in the Department of Anesthesiology of the second hospital of Shandong University. He was appointed to support Guanggu District of Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of science and technology.
Xie Kun remembered that at that time, he and Feng Wei, who was on duty, were carrying a pre prepared eight treasure box - the first-aid intubation box. As they ran forward, they discussed their condition: male, No. 7.5 tracheal intubation was OK; 68 years old, pay attention to protecting teeth, prevent falling off and aspiration by mistake; if the patient coughed obviously, take off the breath and intubation
Stop breathing and then intubation is a jargon, because the tracheal intubation needs to be placed in the patients trachea with the help of laryngoscope during the operation. For conscious patients, it is a foreign body, which will cause severe cough reaction of the patient. The cough reaction on the one hand will affect the patients hemodynamic stability, on the other hand, it will make the anesthesiologist who operates the tracheal intubation feel more Because of the probability of infection, it is necessary to use sedatives, muscle relaxants and other drugs to assist patients to enter drug sleep, so as to create a comfortable intubation environment.
After Xie Kun and Feng Wei entered the ward, the doctors on duty said that they had come quickly, just put down the phone, and then communicated with them about their condition, saying that the patients condition had not improved.
Xie Kun put on protective clothing to enter the contaminated area, and immediately prepared for intubation. Xie Kun remembers that when they came to the hospital bed, the patients oxygen saturation was 87%, drowsiness.
Xie recalled that they had successfully intubated the laryngoscope and tracheal intubation, given auxiliary drugs, and then inserted the laryngoscope and exposed the glottis. When the ventilator is connected, the patients oxygen saturation begins to rise, 90% 99%, success!
Xie Kun is relieved. He remembers that at this time, the clinical patients also gave them thumbs up.
This is just the routine of the emergency intubation team. This emergency intubation team is composed of 12 anesthesiologists from the second hospital of Shandong University, Affiliated Hospital of Qingdao University, Huashan Hospital Affiliated to Fudan University and Ruijin Hospital Affiliated to Shanghai Jiaotong University Medical College. They work in the ward for 12 hours each shift, and they are also responsible for the intubation of critical patients in the infection ward of the whole Guanggu hospital First aid.
Novel coronavirus pneumonia is a very high-risk operation for treating new crown pneumonia. The novel coronavirus pneumonia is the most important way of transmission of respiratory tract infection and respiratory tract infection. When exposed to glottis, the anesthesiologist needs to face the respiratory tract directly and directly. Despite this, we have no recoil and fear. Every tracheal intubation is a race between patients life and time. We are the people who help patients win the time with professional knowledge and extremely responsible attitude. Xie Kun said.
This emergency intubation team, known as intubation dare to die team, has successfully intubated more than 70 cases, with a success rate of 100%.
Difficult critical care
Novel coronavirus pneumonia may be a long time in the afternoon of February 21st, when she was discharged from the first severe new crown pneumonia.
Seeing the happy appearance of the patient when he was discharged from the hospital, Wei Yiqun was very pleased: the treatment process is vivid, very hard, and the process is also very difficult, but all the efforts and efforts are worth it.
Wei Yiqun is the deputy chief physician of the first respiratory department of Shaanxi peoples hospital. On the afternoon of February 2, she, as a member of the second group of medical team in Hubei Province, rushed to the West Hospital of Xiehe Hospital Affiliated to Tongji Medical College of Huazhong University of science and Technology (hereinafter referred to as the West Hospital of Wuhan Xiehe Hospital).
On February 5, Wei Yiqun took over a difficult patient. The patient is nearly 70 years old. When he was admitted to the hospital, he had difficulty in breathing. He turned over a little and was panting. A quick blood test showed type I respiratory failure.
Wei Yiqun dare not neglect - she knows that type I respiratory failure means severe hypoxia, oxygen partial pressure is lower than 60mmhg, and respiratory failure will lead to multiple organ hypoxia damage, and even lead to multiple organ failure, such as heart failure caused by myocardial hypoxia, renal hypoxia may lead to renal failure, etc.
Wei Yiqun decided to correct the patients respiratory failure immediately, so as to guarantee the oxygen supply to the important organs and strive for time for the follow-up comprehensive treatment. She explained that if the pre respiratory failure is not corrected in time, once the patients have multiple organ failure, the mortality rate will be very high. Therefore, the key to the treatment of respiratory failure and severe cases in the early stage is to seize every minute and second, guarantee the patients oxygen supply through non-invasive ventilator, invasive ventilator and other measures, reduce the systemic inflammatory response and multiple organ failure caused by hypoxia Exhaustion and other complications.
Another problem is that the patient has a history of high blood pressure and colon cancer. A novel coronavirus pneumonia was discovered 4 years ago. After operation, there is no recurrence of colon cancer. However, the patient is thin and weak in resistance, and is not good for the treatment of new crown pneumonia. At the same time, long-term hypertension will lead to structural changes of the heart, and even heart failure. In addition to damaging the lungs, the new coronavirus is easy to damage the heart, resulting in viral myocarditis. Therefore, the basic condition of the heart of patients with basic hypertension is not good. After the virus damages the heart muscle, it will aggravate the heart load, resulting in arrhythmia and heart failure Life.
Wei Yiqun decided to actively give patients with ventilator assisted respiration, antiviral, anti-inflammatory, anti infection, immune adjustment, blood pressure reduction, liver protection and other comprehensive treatment of traditional Chinese medicine.
Most of the severe patients involved in breathing, heart, kidney, liver, thrombus, fluid volume, nutrition and other issues, and the rescue focus was meticulous and careful management, comprehensive treatment. For example, for a patient with endotracheal intubation, we consider that its not just to insert the endotracheal intubation and put on the invasive ventilator. This is just a short-term maintenance method. The key is to improve the patients condition through treatment and realize the successful withdrawal and extubation, so that the patient can completely get rid of the life danger. In a word, we should consider all kinds of problems faced by patients comprehensively and take appropriate comprehensive measures as early as possible to manage the treatment meticulously, so as to greatly reduce the death rate of critically ill patients. Wei Yiqun said.
In addition, we should solve the psychological problems of patients. Wei Yiqun recalled that at first, the patient was in a low mood. Every day, he frowned and didnt want to eat. He thought he might not be able to live. I told him that the most important thing for you now is to put down your burden of thinking, eat well and rest well. As the saying goes, evil does not prevail, and immunity is improved. The drugs we use will work better. Wei Yiqun said that through the continuous guidance and encouragement of medical staff, patients anxiety and fear gradually reduced, and they can actively cooperate with the treatment.
One week later, the patients shortness of breath gradually decreased, he could get rid of the ventilator and speak coherently. The diffuse ground glass shadow of bilateral lungs of chest CT was also absorbed. The novel coronavirus nucleic acid test was negative after 9 days after Wei Yiqun and others continued to consolidate their treatment for CT.
This means that after 16 days of treatment, the patient can finally be discharged.
At the time of discharge, the patient said to the medical staff, its my greatest happiness to meet you in white in my life. Thank you for giving me a second life. I must cherish my life, live well and make more contributions to the motherland and the people. Come on, Wuhan! Come on, China!
By February 27, weiyiquns medical team had received more than 70 severe and critical patients. At present, about 18 patients are discharged and transferred to the shelter hospital after treatment, and another 15 are expected to be discharged in the near future.
February 18th, novel coronavirus pneumonia confirmed in Wuhan Raytheon hospital, Xiao Yijiu,
Rescue critical patients
On February 23, Xiangya ward, Xiyuan Hospital of Wuhan Union Medical College set up a temporary ICU for the centralized treatment of critical patients.
There are 6 beds in the temporary ICU. At present, 6 patients have been admitted, 2 of them have been on the ventilator and 2 have been on the high flow respiratory therapeutic apparatus.
Xiangya ward is the original ophthalmic ward of West Hospital of Wuhan Union Medical College Hospital. There was no ICU in the ward. Considering that critical patients were previously distributed in different rooms, there were more human resources needed from the perspective of treatment, and the observation was relatively not timely and sufficient, so it was decided to establish a temporary ICU to gather the critical patients. According to the diagnosis and treatment process and management mode of the critical medicine department of Xiangya Hospital, the medical staff of the critical medicine department, the emergency department and other core departments should be equipped Accurate treatment and centralized management can help to determine monitoring intensity, treatment plan and evaluate prognosis, so as to better improve the treatment effect of critical patients.
After the establishment of the temporary ICU, we have increased the manpower for the temporary ICU. Especially in the allocation of nursing manpower, the bed care ratio is close to 1:3. Central South University Xiangya Hospital (hereinafter referred to as Xiangya Hospital) leader Qian Zhaoxin said.
Severe novel coronavirus pneumonia is mainly caused by virus damage, which is mainly caused by respiratory failure. Oxygen therapy, as the main treatment method to correct hypoxia, has the core treatment status. If hypoxia is corrected, the functional damage of other organs will be reduced and the prognosis will be improved.
The methods of oxygen therapy include ordinary nasal catheter, ordinary mask, gasbag mask, high flow, noninvasive mechanical ventilation and invasive mechanical ventilation. We will evaluate different patients and choose different ways of oxygen therapy. On the whole, all the purposes are to correct the hypoxemia, improve the state of hypoxia, and wait for the recovery of the primary lung disease. Zhang Lina, director of the Department of critical medicine of Xiangya Hospital, said.
Every day in the temporary ICU, doctors from the critical medicine department visit the ward, guide the patients to ventilate in the prone position, use the critical ultrasound to evaluate the daily lung and heart conditions of the patients, carry out the treatment of severe continuous blood purification, and carry out three-level liquid management for the critical patients.
Xiao Xiangcheng, deputy director of kidney Department of Xiangya Hospital, said that continuous blood purification treatment is an indispensable means of comprehensive treatment for critical patients. The so-called continuous blood purification is to use the principles of dispersion, convection, adsorption, ultrafiltration, and other treatment modes, such as hemodialysis, hemofiltration, plasma exchange, etc., to achieve the continuous removal of excessive liquid, urea nitrogen creatinine and other toxins, inflammatory factors and other effects in patients, and to correct electrolyte and acid-base imbalance, and to build a good liquid control platform for patients u3002
The third level liquid management is to manage the patients liquid output and input plan on an hourly basis, so as to reduce unnecessary liquid input and reduce lung injury under the condition of ensuring good perfusion of organs and tissues.
Zhang Lina said that critically ill patients are not hopeless. Doctors want to support the organ function of patients through their own efforts, provide opportunities and platforms for the recovery of primary diseases, and strive for the best possible recovery. As long as there is a glimmer of hope, doctors will never give up.
In February 19th, the novel coronavirus pneumonia was examined by medical staff in the Elephant Lake area of the First Affiliated Hospital of Nanchang University. Peng Zhaozhi was taken to hospital for discharge.
How to deal with the lack of oxygen
Novel coronavirus pneumonia can cause respiratory failure. Most critically ill patients must be given oxygen to carry out follow-up treatment.
Kang Yan and his team initially suffered from an oxygen shortage.
In order to solve the problem of oxygen supply for the West China medical team, Zhang Hongwei, an oxygen engineer from West China Hospital, came to Wuhan the second day, and went to the East Hospital of the peoples Hospital of Wuhan University to learn about the relevant oxygen use problems and the specific situation of the liquid oxygen station. He found that because the oxygen pressure was too low to operate the non-invasive ventilator, it increased the difficulty for the rescue and treatment of severe patients.
The East Hospital of Wuhan University Peoples hospital used steel cylinder oxygen to replace the oxygen supply temporarily to improve the oxygen supply shortage, which brought many problems - the steel cylinder is heavy, the pressure in the cylinder is high when the cylinder is full, the supply, transportation, storage and transfer are troublesome, the cylinder needs to be sterilized when it is used up, and there are potential safety risks.
To solve the oxygen shortage fundamentally, we need to reform the central oxygen supply system of the hospital.
This transformation involves the preparation of various equipment and facilities, and it is expected to take several days to complete the operation in the polluted area. In order to ensure the use of oxygen in the ward during the operation, Zhang Hongwei proposed to temporarily use 40 liters of bottle oxygen, plus 10 sets of cylinder pressure reducing valves with gas terminal sockets brought from West China Hospital, to temporarily guarantee the oxygen supply in the ward. As there is a hidden danger in the use of bottle oxygen, Zhang Hongwei temporarily compiled the operation procedures and precautions for the installation of bottle oxygen decompressor for your reference.
On February 15, the oxygen supply transformation of the hospital center was completed. After 3 days of operation, the oxygen consumption of the ventilator, high flow respiratory humidification treatment instrument and other equipment in the ward was normal, and the oxygen supply problem in the whole East Hospital was basically solved.
Luo Fengming, Secretary of the general Party branch of internal medicine and professor of respiratory and critical care medicine of West China Hospital, said that under the limited conditions, the West China medical team constantly innovated treatment methods to deal with the reality of oxygen deficiency. We creatively propose the traditional high flow rate + mask cylinder oxygen supply, or noninvasive ventilator + nasal catheter cylinder oxygen supply to improve patients oxygenation, which is simple and easy to operate, and has good clinical response.
In view of the insufficient oxygen pressure, the West China medical team connected the steel cylinder to the nasal catheter, and then connected the nasal catheter to the patients mask. Some masks can be directly inserted into the oxygen tube. If the mask cannot be directly inserted into the oxygen tube, put the nasal catheter into the patients nose to increase the oxygen supply. This is a small innovation that can increase the oxygen supply of patients when the oxygen pressure is not particularly enough. Luo Fengming said.
After improving the oxygen pressure of the central oxygen supply, the oxygen pressure increased significantly. With the guarantee of oxygen, the patients anoxia will definitely improve a lot. This is great news for us. Luo Fengming said.
Nursing should not be ignored
In February 19th, novel coronavirus pneumonia was reported in the Eastern Hospital of Wuhan University peoples hospital. The first ward of the two wards of Qilu Hospital, Qilu Hospital, was discharged from hospital, and 2 patients were discharged from hospital.
One of them is an 88 year old man. Although the elderly has been discharged from the hospital, the medical team is still analyzing the whole process of her treatment, hoping to sum up experience and apply it to the treatment of other elderly severe patients.
The old man, who lives in Jianghan District, began to have fever on February 1 this year, with a fever of 38.9 u2103. In addition, he was old and complicated with hypertension and diabetes. At the same time, the elderly lie in bed all the year round, unable to take care of themselves. There are deep pressure sores in the sacrococcygeal region, and long-term eating difficulties lead to serious malnutrition.
Qilu medical team understands that the development of the elderly patients with other chronic basic diseases is not optimistic, but it is also an important breakthrough point to improve the cure rate and reduce mortality.
After taking over the ward, Qilu medical team will grade the patients, carry out multi-disciplinary consultation for the patients with high risk and many complications, and formulate individualized treatment plan. Specifically for this old man, the medical team paid special attention to the strict control of blood sugar and blood pressure, improvement of intestinal flora, monitoring of liver function, renal function, electrolyte and other conditions, and timely treatment of the disease while treating his pulmonary infection.
After symptomatic treatment, the old mans condition improved greatly, but he ate very little. Hou Xinguo, a member of the team, proposed to call the old mans daughter and find out that the old man likes porridge. The team members are worried that the elderly cant keep up with their porridge nutrition, and they use the wall breaking cooking machine to make nutritious food such as eggs, vegetables and meat into the porridge.
Serious pressure sores in the sacrococcygeal region of the elderly often cause discomfort. Zheng Huizhen, deputy head nurse of the medical team, led the nursing team to clean the wound and change the medicine, turn over and clap the back, and the pressure sores of the elderly began to recover.
Gao Shuai, a member of Qilu medical team and chief physician of Hepatology department, wrote in her diary that when she visited the ward at night, she held my hand tightly, and her face was full of vicissitudes and was touched.
As of February 27, 82 serious patients had been treated in the two areas taken over by the fourth and fifth aid medical teams in Shandong Province, of which 5 were cured and discharged, 14 were transferred from severe to light illness to the shelter hospital, and 1 died.
Fei Jianchun, head of the Qilu medical team and deputy director of the medical department of Qilu Hospital, said that at present, there are beds and others in their two wards.