65438+ 10: 30 in the morning of October 3 10: 30, an ambulance drove into Minhang Hospital affiliated to Fudan University. The blood oxygen saturation of patients in their 90 s is only about 80, and the medical staff will receive treatment immediately. Entering the emergency hall, the seats of patients waiting for treatment have been removed, and the vacated large area has been changed into a "temporary observation room", where many patients are lying in hospital for observation. Entering the peak of intensive care, many medical staff stick to the front line. Minhang Hospital affiliated to Fudan University has launched a number of measures, such as "all-hospital consultation", "all-hospital emergency assistance" and "medical outpatient diversion", to gradually restore order and shorten the waiting time of patients. Sun Keyu, director of the emergency department, pointed to the emergency hall and said:
"It's very orderly now. It turns out that there are people here. "
The peak of critical care is coming,
The emergency department can receive more than 2000 people a day at most.
65438+10.2, the total number of emergency patients 1820, 847 in internal medicine, 98 in emergency observation, 24 hours 120 trains 135 ".
In the emergency department working group of Minhang Hospital affiliated to Fudan University, medical staff summarized the emergency data of the day. Sun Keyu said: "We usually have more than 1,000 people in emergency/kloc-0, more than 20 people in detention, and more than 300 people in emergency every day.
Recently, the number of outpatients and emergency patients has peaked at more than 2,000, with nearly 1,000 emergency patients staying1000. All the people stranded in the emergency room come at night and have to be hospitalized the next day. "
In the morning 10: 30, an ambulance drove into the hospital, and the medical staff immediately received treatment. This patient is over 90 years old and was sent from a nursing home. When he arrived at the hospital, the examination showed that the oxygen saturation was only about 80.
At this time, the beds in the emergency room are full, and the waiting hall outside the rescue room is also crowded with beds for observation. The original seats for patients waiting for treatment were removed, and the large area vacated was changed into a "temporary observation room" for patients staying in the hospital to lie in.
"The patient's condition needs oxygen immediately. He was given oxygen pillow first, and then the doctor immediately evaluated it. The neurology department has just vacated a bed and arranged for the elderly to live in the neurology department first. " Xie, the head nurse of the emergency room, said that many young people will have a high fever this time.
However, many elderly people may not have a high fever, but they all developed hypoxemia after coming, which is also a recent situation.
From 12 to 19, the number of patients in the emergency department of Minhang Hospital affiliated to Fudan University increased rapidly. "A room full of people can't be diverted." Someone sent a message in the work group that day, and this was just the beginning of the peak of medical treatment. Enter the peak period,
The hospital receives 120 ambulances over 200 times a day at most.
With the increasing number of emergency patients, hospitals have taken measures to divert them to other departments. "Not only internal medicine, but also surgery accepts patients." Sun Keyu said,
On February 25th, 65438, the number of emergency visits reached 2352, and 55 people were stranded in the emergency room, with 24-hour train trips 1 18. After the shunt began, patients were assigned to wards of various departments. At this time, the number of detainees has dropped.
"We girls,
They all said,' I'm going to work the night shift today' "
Also from this week, a large number of medical staff were infected with COVID-19 virus. "I am the earliest infected person in our department. After I came back from 65438+February 19, I entered the emergency peak. " Sun Keyu said that he has been engaged in first aid work for more than 20 years and has never been so busy. He rotates every day.
In Sun Keyu's office, there is a folding bed, and sometimes it is too late to live here. In addition to coordinating various tasks, he sometimes appears in various positions. On February 26, 65438, a doctor sent a message in the work group that he had been "sending patients" and "looking for patients" that day, pushing patients who needed to be hospitalized in the emergency room to the ward.
"After entering the emergency peak, the medical staff with high fever rested for a day or two, and basically insisted on not having a fever or a low fever." One night at 9 o'clock, a nurse found Sun Keyu with tears in her face: she said,' I really can't keep going'. There's too much pressure. Patients flooded in, and it was too late to do it. The medical staff themselves have a fever. I have never encountered such a situation before, and then I told them how to simplify the process and so on. "
When interviewed by reporters yesterday, Xie Xianghai kept coughing. She hasn't had a day off since she fell ill on February 20th, 65438. "Because I am here, is their spiritual pillar. Even if you can't do it, you can coordinate with them. "
Speaking of recent emergencies, thank you.
I couldn't help crying several times:
"The workload of the emergency department has increased several times, and the medical staff have also been infected, and many of them have a fever. These are all arranged as far as possible. But we girls, all in the emergency department, all know the difficulties now.
They all told me,' I have to work the night shift today. It's wrong to work the night shift with a high fever, but there's really nothing I can do. It's pitiful that patients and medical staff should understand each other. "
"It is still on the peak platform, and now is the most difficult time.
As director Zhang Wenhong said yesterday, it is expected to last for another two weeks. Sun Keyu said that the ward is full now, and only someone can leave the hospital to make room. The biggest difficulty is that patients need to be hospitalized, but "one bed is hard to find". It is expected that the number of ambulances will decrease in the future, but the diseases that may be sent will be heavier.
The waiting time was shortened from 6 hours to 2 hours.
The hospital gradually restored order.
The peak of intensive care has already begun. At present, the hospital is gradually restoring order, and the waiting time of patients is gradually shortening.
"It will take about 6 hours at the peak, and the waiting time from the 3 rd has been shortened, estimated to be about 2 hours."
Shao, deputy director of the emergency department of Minhang Hospital affiliated to Fudan University, told the reporter: "Since June 5438+1October 3, there have been more people waiting in line. There were three people in the emergency department in the morning. Now there are 5 people in the emergency department during the day, 6 people at night and 9 people at the weekend. At the same time, the fluid supplement can be opened for two or three days at a time, and there is no need to queue up every day, and some of them are diverted to the fever clinic. "
In order to cope with the peak of critical care, hospitals
A number of measures have been initiated, such as "accepting patients in the whole hospital", "assisting emergency in the whole hospital" and "diverting medical clinics".
Sun Keyu introduced that these patients were originally admitted to internal medicine, such as emergency medicine, gastroenterology, respiratory medicine, cardiovascular medicine, nephrology, general medicine and geriatrics.
Now all departments will be admitted. The number of doctors in the emergency room increased from 9 to 17. The extra eight doctors were transferred from the ward, and then doctors from other departments were added to the ward.
"Our hospitals and community health service centers are also linked. After several days of treatment, patients with stable condition will be transferred to community hospitals in time to make room. In addition, the medical clinic originally located in the emergency department 1 floor was moved to the hospital research building 1 floor, which greatly diverted the flow of people. " Sun Keyu said.
"The hospital has also explored the order now, and the citizens are also very cooperative. Everything will be fine." Xie said to:
"I also told my colleagues that I finally saw the sun and the temperature was rising. It will definitely get better."
Sun Keyu also reminded that patients with mild symptoms or mild cough and good blood oxygen saturation can go to the community health service center for medical treatment and prescription, and nutritional support is very important. It should also be noted that among emergency patients, some patients will immediately run to the hospital when they see that the blood oxygen saturation is somewhat low, but there is no problem in repeated re-examination in the hospital. It is recommended to purchase a pulse oximeter through regular channels and seek medical advice in time when symptoms of chest tightness and shortness of breath appear.
Xu Xinhui, deputy director of the emergency department of Renji Hospital, is responsible for the work of the emergency intensive care unit. "Compared with lying flat in supine position, gravity presses on the lungs, and prone position can better improve lung ventilation, and every time a patient is ventilated in prone position, it often needs four or five medical staff to complete it together." He said, "The monitoring room has 15 beds, which are running at full capacity every day, and some patients are waiting in line for beds.
Gao Yuan, director of the Department of Critical Care Medicine, kept calling. In ICU, patients with severe pneumonia account for half, and a quarter of them are patients whose basic diseases worsen after infection. During the New Year's Day holiday, almost all of the graduate students, rotation doctors, department medical staff, etc. 180 people were employed.
When talking about the characteristics of critically ill patients recently admitted, Gao Yuan introduced that they are mainly elderly people and men.
Wuyuan said frankly, "We are very sad to find that many patients have missed the best opportunity when they arrive at the hospital. I don't want to stay at home because there are many emergency patients. Preventing a minor illness from turning into a serious illness is more important than treatment. "
News+
During the Great Shanghai Defence War, there were people dancing in the air-raid shelter. Why is the proportion of symptoms increasing at present?
How to block serious diseases at the grassroots level?
What support does medical care need most?
Chen Erzhen, vice president of Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine and a member of Shanghai COVID-19 Rescue Expert Group, accepted an exclusive interview with People's Daily Dajiangdong Studio.
Q: Have you ever been infected? In the Great Shanghai Defence War, you participated in the construction of the seventh cabin, and we also interviewed the cabin where you presided over medical treatment. We found that the proportion of asymptomatic infected people was quite high in the past, and now everyone feels that the proportion of symptomatic people has increased significantly. Why?
Chen Erzhen: COVID-19 is generally susceptible to human beings, and different people have different clinical manifestations after infection. I have been infected, and the symptoms are very mild. I have a fever of 38.5 degrees, and I will be fine in half a day. I don't have a headache or muscle pain, which may be related to my whole vaccination, or I may encounter a small viral load.
Now it seems that it is really different from the period of defending Shanghai. At that time, more than 600,000 infected people in Shanghai were screened out by whole nucleic acid examination, and many of them were isolated in shelters without symptoms. At present, the epidemic in Shanghai has spread widely, which may have reached 70% of the population, 20 to 30 times more than that at that time. In absolute terms, everyone must feel that there are more people with symptoms.
For the proportion of asymptomatic infected people, further statistical judgment is needed.
Q: Is it necessary for many people to go to the hospital for CT because of chest tightness and shortness of breath? What situation suggests going to the hospital? Do I still need to wear a mask when I go home to treat patients? "Yang", what should the elderly who are not very symptomatic pay attention to?
Chen Erzhen: CT is indeed the key means for imaging to judge whether there is pneumonia. According to the four types, there are no indications of mild pneumonia, common pneumonia and severe and critical pneumonia. Most patients, especially young people, have a very, very low probability of pneumonia. Unless there are obvious symptoms of pneumonia, CT is generally not needed.
High-risk patients must undergo CT screening, such as elderly patients over 65 years old, whose CT positive rate is relatively high. Please listen to the doctor. The doctor will judge whether you need a CT scan. Some people don't have a fever and cough a little. If they cough for a long time, they will feel a little chest tightness, but there are no blood tests such as shortness of breath, white blood cells, lymphocyte decline and oxygen saturation. There's no need for a CT scan. Blindly rushing to the hospital and crowding out medical resources will affect those who really need treatment.
Yang Kangren doesn't need to wear a mask at home. But you still have to wear it in crowded places. I have read an overseas study, and the sample of more than 800,000 people has a secondary infection rate of 2% to 3%. This may be related to the interval between two infections and the immune function of the infected person. For your health, please adhere to the "three-piece suit" and "more than five".
Old people who are yang but have no symptoms should pay special attention. The activity ability and reaction ability of the elderly are declining, and the clinical characteristics after infection are different from those of the young. Maybe pneumonia has happened, but it's just drowsy, unresponsive and inconvenient to move. Pay special attention to elderly people living alone. The oximeter can monitor, but it is not everything. It is also necessary to observe whether the elderly are slow and unconscious, whether the skin and mucosa have changed, and whether the colors of lips and nails are a little purple. If accompanied by persistent fever, cough and chest pain, the risk is even greater. You should go to the hospital to see if there is inflammation in the lungs through CT and other means.
In a special period, medical staff always stick to the front line. They are human beings, but they insist on working hard to protect people's health. I hope they can take care of themselves and be healthy!