January 3, 10:30 a.m., an ambulance into the Fudan University Affiliated Minhang Hospital, more than 90 years old, the patient's blood oxygen saturation is only 80 or so, the medical staff immediately received. Into the emergency hall, the original waiting seats for patients have been removed, leaving a large area converted into a "temporary observation room", where a number of patients lying in the hospital for observation. Entering the peak of critical care, many health care workers stick to the front line. Fudan University Affiliated Minhang Hospital started "the whole hospital to collect patients" "the whole hospital to help emergency" "triage internal medicine clinic" and many other measures to gradually find the order, the patient waiting time is also shortening. Emergency department director Sun Keyu pointed to the emergency hall, said,
"Now orderly, originally here is full of people."
The peak of critical care visits arrived,
The emergency department received more than 2,000 people a day at most
On Jan. 2, the total number of people in the emergency department was 1,820, the number of people who received internal medicine was 847, the number of people stranded in the resuscitation room was 98, and the number of 120 trips in the 24-hour period was 135."
Inside the work group of the Emergency Department of the Fudan University-affiliated Minhang Hospital , medical staff summarized the day's emergency care data. Sun Keyu said: "Our usual emergency volume of more than 1,000 people, stranded more than 20 times, emergency medicine up to more than 300 people a day.
Recently the peak emergency volume reached a maximum of more than 2,000 people, emergency medicine nearly 1,000 people, stranded more than 100 people, the resuscitation room stranded are coming over at night, the next day to do hospitalization."
At 10:30 a.m., an ambulance pulled into the hospital and paramedics immediately took over. The patient, who was in his 90s and had been sent from a nursing home, arrived at the hospital with tests showing an oxygen saturation of only about 80.
At this time, the beds in the emergency room were full, and the waiting hall outside the emergency room was also crowded with beds for observation. The original waiting seats for patients have been removed, leaving a large area converted into a "temporary observation room", lying in the hospital observation of the patient.
"The patient's condition requires immediate oxygen, gave him an oxygen pillow to inhale, and then the doctor immediately assessed the neurology department just vacated a bed, the old man will be arranged to the neurology department first stay." Xie Haixiang, head nurse of the emergency resuscitation room, said that many young people in this new crown will have a high fever,
But many elderly people do not necessarily have a high fever, but come with hypoxemia, which is also the most recently received situation.
Starting on Dec. 19, the number of visits to the emergency department of Minhang Hospital affiliated with Fudan University increased rapidly. "The room is full of people, and triage can't be done." Someone posted a message in a work group that day, and that was just the beginning of the peak in attendance. Going into the peak,
The hospital received more than 200 120 ambulance trips a day at most.
The growing number of emergency cases has led the hospital to take measures to divert patients to other departments. "It's not just internal medicine, but surgery is also accepting patients." Sun Keyu said,
On Dec. 25, emergency room visits reached 2,352, with 55 people stranded in the resuscitation room and 118 24-hour 120-vehicle trips. After triage was initiated, patients were assigned to various departmental wards, and by this time the stranded numbers had come down.
"We girls,
were saying 'I have to work off the night shift today'"
It was also from this week that a large number of healthcare workers contracted the new coronavirus. "I was the first one to get infected in our department, and when I came back on Dec. 19, it was the peak of the emergency room." Sun Keyu said that after more than 20 years of working in emergency medicine, he had never been so busy, turning around every day.
In Sun Keyu's office, there is a folding bed, sometimes time too late to stay here. In addition to coordinating the work, he sometimes appeared in various positions. December 26, a doctor in the work group message that he has been "sending patients" "looking for patients", the rescue room needs to be hospitalized patients pushed to the ward.
"Entering the emergency peak, Yang had a high fever of health care workers to rest for a day or two, no fever or a low fever basically adhere to." One night at 9:00 p.m., a nurse found Sun Keyu lost her voice and cried: she said 'I just can't hold on', the pressure was too much, patients came in like a tidal wave, it was too late to do anything about it, and the health care workers themselves had a fever. I've never been in this situation before, and then I talked to them about how to streamline the process and so on."
In an interview with reporters yesterday, Xie Haixiang had been coughing non-stop. She hadn't rested a day after her Dec. 20 sunrise. "Because I came, is their spiritual support. It is to do not move, but also can give them coordination."
Talking about the recent emergency situation, Xie Haixiang
several times to hold back tears:
"Emergency workload increased several times, at the same time the medical staff also infected, many are feverish, these are as far as possible to arrange rest. But we girls, all of us in emergency medicine, know how difficult it is now,
They all told me 'I have to work off the night shift today', and it's not right to be working the night shift when you have a high fever, but there's really no way around it. Both patients and medical staff have to understand each other, it's all quite sad."
"It's still on the plateau of the peak, and now is the toughest time.
Like director Zhang Wenhong said yesterday, it's expected to last another two weeks." Sun Keyu said that the wards are now full, and only when someone is discharged can the beds be vacated, the biggest difficulty is that patients need to be hospitalized, but "it's hard to find a bed." In the future, the number of ambulance trips is expected to drop, but the condition of the patients may be more serious.
Waiting time shortened from 6 hours to 2 hours
Hospitals gradually finding order
The peak of serious illnesses has already begun, and hospitals are gradually finding order, with patients' waiting times gradually being shortened.
"At the peak, you had to wait for about six hours, and the waiting time has been shortened since the 3rd, estimated at about two hours."
Shao Jinyan, deputy director of the outpatient and emergency office of Minhang Hospital affiliated with Fudan University, told reporters, "From Jan. 3 we have more people lined up, it was usually three people in the morning in the Department of Emergency Internal Medicine, and now it is five people during the day in the Department of Emergency Internal Medicine, and six people at night, and more than nine people in the case of a double holiday. At the same time, the amount of rehydration fluids can be prescribed for two or three days at a time, so you don't have to come to the line every day to prescribe them, and there is some diversion to the fever clinic."
In order to cope with the peak of critical care, the hospital
initiated a number of measures such as "hospital-wide admission of patients," "hospital-wide help for emergency" and "triage of internal medicine clinics."
Sun Keyu introduced, originally these patients are to be internal medicine, such as emergency medicine, gastroenterology, respiratory medicine, cardiovascular medicine, nephrology, general medicine, geriatrics, etc.,
Now all departments will be admitted. The number of doctors in the resuscitation room has increased from nine to 17, with the eight additional doctors drawn down from the wards and then supplemented by doctors from other departments.
"Our hospital and community health centers are also linked, after a few days of treatment, the condition of the patient stabilized will be transferred to the community hospital, in time to free up beds. In addition, the internal medicine clinic, which was originally located on the 1st floor of the emergency room, was moved to the 1st floor of the hospital's research building, which greatly diverted the flow of people." Sun Keyu said.
"The hospital is now also figuring out the order, the public is also cooperating, all will be fine." Xie Haixiang said,
"I also told my coworkers that we are finally seeing the sun and the temperature is rising, so it will definitely get better."
Sun Keyu also reminded that mildly ill patients or those with a slight cough and okay oxygen saturation can visit community health centers for medication dispensing, while nutritional support is very important. It should also be noted that in the emergency patients, there are some patients see some low oxygen saturation will immediately run to the hospital, but to the hospital retesting many are no problem, it is recommended to buy finger pulse oximeter through the regular channels, chest tightness, shortness of breath symptoms should be timely medical care.
Renji Hospital's emergency department deputy director Xu Xinhui is responsible for the work of the emergency room, "compared to the supine position lying flat, gravity are pressed on the lungs, prone position can better improve pulmonary ventilation, and every patient to do prone position ventilation, often need four or five health care **** with the completion of the work." He said, "There are 15 beds in the care unit***, which is at full capacity every day, and there are still some patients waiting in line for beds.
The cell phone of Gaoyuan, director of the Department of Critical Care Medicine, is always ringing. Half of the ICU is filled with patients with severe pneumonia, and a quarter with patients whose underlying diseases have worsened after infection. Over the New Year's Day holiday, almost all of the 180-plus people, including graduate students, rotating doctors and the department's medical staff, were on duty.
When talking about the characteristics of the critically ill patients admitted recently, Gaoyuan described a predominance of advanced age and males.
Gao Yuan frankly, "We are heartbroken to find that many patients to the hospital has missed the best time, do not want to stay at home because of the emergency crowd, to prevent minor to serious illnesses is more important than treatment."
News+
During the period of the defense of Shanghai, square pods still have people dancing in the square, why the current proportion of symptomatic instead of rising?
How can the grassroots block serious illness?
What support do healthcare professionals need most?
Chen Erzhen, vice president of Ruijin Hospital affiliated with Shanghai Jiaotong University School of Medicine and a member of the Shanghai New Crown Treatment Expert Group, was interviewed by People's Daily's Dajiangdong Studio.
Q: Have you ever been infected? During the defense of Shanghai, you participated in the construction of seven compartments, we also interviewed you presided over the medical treatment of the compartments, found that the infected people have square dancing, singing, the proportion of asymptomatic infected people is quite high, and now we all feel that the proportion of symptomatic significantly higher, why?
Chen Erzhen: new coronavirus for humans, universal susceptibility, different people infected with different clinical manifestations. I have been infected, the symptoms are very mild, fever to 38.5 degrees, half a day, no headache, muscle pain, may be related to my full vaccine, but also may come across a lower viral load.
Now, it does not seem to be quite the same as it was during the defense of Shanghai. At that time, more than 600,000 infected people in Shanghai were screened by the full nucleic acid test, of which those isolated in the square cabin, many of them asymptomatic. Now the epidemic in Shanghai is so widespread that it may have reached 70% of the population, more than 20 or 30 times the number at that time. In terms of absolute numbers, one is bound to feel that more people are symptomatic.
The proportion of asymptomatic infections in this wave needs to be further investigated through statistical data.
Q: Many people go to the hospital for CT when they have chest tightness and shortness of breath, is it necessary? What conditions are recommended to go to the hospital? Cured patients go home, still need to wear a mask? "Yang", less symptomatic elderly should pay attention to what?
Chen Erzhen: CT is really a key tool in imaging to determine whether there is pneumonia. According to the four types of classification, the light type does not have the manifestation of pneumonia, the ordinary type has the manifestation of pneumonia, and the severe and critical type also has the relevant indications. The vast majority of patients, especially young people, have a very, very low chance of developing pneumonia, and unless there are obvious symptoms of pneumonia, CT is generally not necessary.
CT screening is mandatory for high-risk patients, such as those over 65 years of age, who have a higher percentage of positive CTs. The doctor will determine whether you need to do CT, some people do not have a fever, a little cough, cough a long time will be a little chest tightness, but there is no shortness of breath, white blood cells and other blood routine is also good, there is no drop in lymphocytes, oxygen saturation is also good, it is not necessary to do CT. blindly flocked to the hospital, crowded medical resources, will affect the real need to save the lives of those who are in need of medical treatment.
There is no need to wear a mask at home. But they should still wear them in crowded places. I've seen an overseas study with a sample of over 800,000 people, and the rate of secondary infections was in the 2% to 3% range. This may be related to the time between infections, as well as the immune function of the infected person, for your health, please adhere to the "three-piece suit" "five more".
Elderly people who have been infected but are not quite symptomatic should be especially concerned. Older people's mobility and responsiveness are declining, and the clinical features of the infection are different from those of younger people. Pneumonia may have occurred, but only lethargy, slower reaction, mobility. Particular attention should be paid to elderly people living alone. Oximeter can monitor, but it is not everything, but also to observe whether the elderly are unresponsive, confused, whether the skin mucous membrane changes, lips, nails color is not a little purple. If accompanied by persistent fever, cough, chest pain, the risk is even greater, we must go to the hospital, through CT and other means to see if there is inflammation in the lungs.
Special times, health care workers always stick to the front line, they are also mortal body, but to guard people's health, grit their teeth, fight bravely, I hope that they are able to take care of the body, healthy!