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2023-1-711:45 from the official account of Shanghai The Paper.
From June 5438 to February last year, Wang Ruilan, an expert in critical care medicine, went to the hospital at 7: 30 every morning and worked until 7: 30 in the evening, or even later.
Everything is to treat patients in COVID-19. From mid-June, 5438 to February, 2022, the Shanghai Municipal Health and Health Commission set up a municipal-level expert group on severe diseases to make overall arrangements for experts in severe treatment and strengthen the prevention and treatment of severe patients. Among them, the municipal expert team *** 132 people, including 82 people in emergency and intensive care departments, is divided into 16 expert teams according to the administrative division of Shanghai 16, and cooperates with the expert team composed of the district health and health commission and the multidisciplinary intensive care teams of medical institutions at all levels to improve the treatment level of severe patients.
Wang Ruilan, director of emergency and critical care department of Shanghai First People's Hospital, is a member of the municipal critical care expert group. He talks about difficult cases online in Hongkou District, and occasionally goes to the scene for guidance and offline communication. Li Yingchuan, an expert in critical care medicine from Shanghai Tenth People's Hospital, went to Putuo District, and his team of experts sank to Putuo District Central Hospital, Putuo District People's Hospital, Changshou Street Community Health Service Center and Changzheng Town Community Health Service Center.
"In fact, the greater significance of municipal experts sinking into the community is to discuss with you how to identify high-risk patients more accurately, prevent them from turning into serious diseases, and reduce the conversion of serious diseases into critical diseases. At present, the focus of our work is to prevent and treat serious diseases, reduce serious and critical diseases as much as possible, and move the gateway forward, so as to use more intensive care resources of tertiary hospitals, municipal hospitals or central hospitals to effectively rescue severe patients. This is our unanimous goal. " Li Yingchuan said.
According to the introduction of Shanghai Municipal Health and Health Commission1October 6, 132 municipal experts have consulted for 2 16 rounds, consulting for 333 times, and submitted to the whole city for consultation 126 times. There are 579 experts in 16 district, and 698 remote consultations have been carried out, guiding 3283 patients in the community for on-site treatment.
Li Yingchuan's working scene. The pictures in this article are provided by the respondents.
Guide the treatment of critically ill patients.
6543816, our reporter (www.thepaper.cn) learned from Li Yingchuan, vice president of Shanghai Tenth People's Hospital and chief physician of the Department of Critical Care Medicine, that the municipal expert group cooperated closely with the expert groups at the district and hospital levels, and carried out the treatment of critical illness in Shanghai in an orderly manner, relying on the daily dispatch meeting system, the examination and consultation system for critically ill patients at the municipal and district levels, and the two-way counterpart referral system for critically ill patients at the municipal and district levels.
Li Yingchuan is an expert in critical care medicine and the head of the expert group of critical care medicine in Putuo District. The expert group led by him * * * has eight members, from the tenth people's hospital, chest hospital, a maternity and infant hospital, cancer hospital and other municipal hospitals. During this docking in Putuo District, Li Yingchuan and his team members sank to Putuo District Central Hospital, Putuo District People's Hospital, Longevity Street Community Health Service Center and Changzheng Town Community Health Service Center, and participated in rounds and consultations for many times to carry out special training.
Li Yingchuan and his team of intensive care experts.
Li Yingchuan introduced that his job is mainly to provide treatment guidance for the first-and second-class hospitals and community health service centers within his jurisdiction. "For example, when dealing with emergency and rescuing critically ill patients, district-level hospitals will follow some drug treatment schemes for critically ill patients in COVID-19, and sometimes they will meet some patients whose condition is relatively critical or whose symptoms are acceptable, but ct images show that their condition is developing to critical condition. Some details of diagnosis and treatment need further communication before they can be determined. In this process, our expert group needs to explore how to better treat such patients, including anti-infection treatment programs and control of chronic diseases. "
He said that at present, hospitals in Shanghai are under great pressure of severe emergency, and most of the guidance is conducted online; There will be some situations that need offline guidance, and experts need to go to the hospital or community health service center in the district for on-site guidance. In addition, for patients and their families, some guidance on treatment and rehabilitation will be provided through education and outpatient follow-up.
According to the two-way counterpart referral system for critically ill patients in cities and districts, in principle, critically ill patients are treated on the spot, and consultation experts participate in the treatment in various ways such as online, on-site or on-site guidance. If referral is really necessary after consultation by municipal experts, counterpart referral shall be made through the three-level treatment network system in the area according to the principle of "coordination between hospitals and districts". After the patient's condition is stable, he will return to the original transferred medical institution to continue treatment according to the principle of "first diagnosis is responsible". However, Li Yingchuan said that such cases requiring referral are not common, because the medical facilities (such as ventilators) of most district-level medical institutions have been able to meet the treatment needs of common serious diseases. However, if it is particularly serious and complicated, it is often impossible to transport it because the risk of transshipment is too great. "So far, we have not encountered such a special situation, and there are few cases of actual transshipment."
In addition to providing treatment guidance to critically ill patients, experts at the city and district levels will also provide special training to hospitals and community health service centers within their respective jurisdictions. "At the beginning of the epidemic from June 5438 to February 2022, under the guidance of Shenkang Group and the Municipal Health and Health Commission, relying on the Committee on Critical Care Management and the Committee on Medical Quality Management of the Hospital Association, a series of systematic trainings were conducted for various medical institutions, including the basic work on critical care in COVID-19 and COVID-19, all of which were conducted online. I invited critical care experts and specialists from all over Shanghai. I am the chairman of the Committee on Critical Care Management of the Hospital Association and am also responsible for some training contents." Li Yingchuan said. Judging from the situation in the whole city, up to now, the municipal expert group * * * has conducted 43 special trainings, and the district experts * * * have conducted special trainings 133 times.
"Through the special training some time ago, district-level and community doctors are basically familiar with the treatment plan for infected patients in COVID-19 and have mastered the treatment methods for critically ill patients." Li Yingchuan said that these hospitals are doing well and have practical experience. At the same time, through the front-line guidance of the expert team, the professional ability of the primary medical team has been further improved, and through effective mechanisms, critically ill patients in urgent need of treatment have been effectively treated and recovered as soon as possible.
Li Yingchuan's working scene.
Discuss difficult cases online
Wang Ruilan is the director of the emergency and critical care department of Shanghai First People's Hospital, who once supported Wuhan in fighting the epidemic.
As a member of the municipal expert group, she needs to be responsible for guiding the work of Hongkou District Community Health Service Center, visiting the secondary hospital for inspection and rounds from time to time, and discussing with the doctors in the hospital. Since 65438+February last year, Wang Ruilan has kept the habit of getting up at 6: 30 every morning and arriving at the hospital at 7: 30, working 12 hours a day.
On the afternoon of October 6th, 65438/KLOC-0, Wang Ruilan had an online meeting with the emergency department doctors of Shanghai Fourth People's Hospital to discuss the treatment of difficult cases. Earlier in the day, an old man with septic shock was taken to the Fourth People's Hospital with low blood pressure. After giving him intensive medicine, Wang Ruilan suggested finding the infection site and source of the patient. At present, the elderly have been admitted to the internal medicine ward of the Fourth People's Hospital of Shanghai for treatment.
After the online meeting, Wang Ruilan went to Quyang Community Health Service Center for guidance. "There partition triage, overall doing quite well. The medical staff will ask each patient's medical history and vaccination status, and measure their blood pressure and blood oxygen saturation as appropriate, and divide them into light, ordinary, heavy and critical patients according to the patient's situation. " Wang Ruilan introduced that patients with different degrees have different coping strategies. Usually, mild patients are advised to be treated at home. Ordinary patients receive infusion and oxygen delivery at the community health service center first, and severe and critically ill patients are directly transferred to higher-level hospitals for treatment. In case of special circumstances, such as severe patients with thrombosis, the community health service center will immediately give anticoagulant treatment. At the same time, the sinking of municipal experts has also provided practical help for district-level medical institutions and community health centers.
On October 28th, 20201October 28th, 65438, Wang Ruilan went to Wuhan for support. She still remembers treating patients at that time. One of the patients was discharged from the hospital a month later and sent her a video of playing the trumpet. "That was the most touching time for me."
"In the past three years, all the experience has accumulated a little, and the experience of Wuhan is also very important. I think the most important measure is prone position ventilation. " Wang Ruilan said that prone position ventilation can help patients avoid the pain of tracheal intubation. Today, she still uses this experience to do prone ventilation for patients in need, and also teaches this treatment to doctors in secondary hospitals and community health centers.
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