With the release of "Ten Articles of New China", hospitals have become the first "breakwater" facing the wave of infection.
Recently, the reporter approached the ICU department of the affiliated hospital of Qingda University, and directly hit them in the ICU to fight the virus and race with death.
23 elderly people, 2 1 person were infected with COVID-19.
Someone's oxygen saturation has dropped to 80% to come to first aid.
As a first-line department, ICU treated all critically ill patients after triage after the arrival of infection tide. Liang Shan, director of the South Ward of the Department of Critical Care Medicine of the Affiliated Hospital of Qingda University, clearly felt the impact brought by COVID-19.
As a result of COVID-19's symptoms, the patients admitted to the hospital became more and more serious. More and more patients with chest CT images showing "white lungs" were sent in, and the medical staff experienced the dilemma of continuous downsizing.
Liang Shan is discussing the patient's condition with his family. Due to COVID-19's infection, the old man's lungs became "white lungs"
An ICU ward in Nanyuan District has 23 comprehensive beds and has treated 23 elderly people, the oldest being 92 years old. Among them, 2 1 elderly people were infected with COVID-19.
They already have serious basic diseases, or hypertension, coronary heart disease, ketosis, heart crossing the bridge, or serious vascular diseases. Coupled with COVID-19 infection, lung oxygen function is poor, and some patients even fall into a coma when their oxygen saturation drops to 80%, and are directly sent to the hospital for emergency treatment by their families.
Since 654381October 8th, China has officially implemented "B and B management" for COVID-19 infection. The "Overall Plan for Implementing" Type B and Type B Tubes "in novel coronavirus" proposes to increase investment in medical resources construction, focus on preparing inpatient beds and critical beds, and equip critical treatment equipment such as large-flow respiratory treatment equipment, ventilator and extracorporeal membrane oxygenation to improve oxygen supply conditions.
In order to better cope with the "climax" of severe diseases, the Affiliated Hospital of Qingda University set up a rescue team for critically ill patients to strengthen the treatment of critically ill patients. Organize discussion on difficult cases of patients with severe pneumonia at a specific time every day, and use emergency ICU, neurosurgery ICU, cardiac surgery ICU, respiratory ICU and other specialized ICU to treat severe patients, and fully protect patients from seeking medical treatment.
As the director of ICU South Ward, Liang Shan has been busy with the team for nearly a month, regardless of illness or not. From morning till night, he almost kept shuttling between sickbeds, always nervously observing the patient's condition changes, and the head nurse of the Department of Critical Care Medicine of the Affiliated Hospital of Qingda cooperated with him to adjust the medication and ventilator parameters in time.
At the beginning of the peak of social infection, most medical staff in the department were also infected. As leaders, the two of them are in a state of "preparing for war" every day, and every on-the-job medical staff has become a "super soldier". In the face of the sudden surge of patients, they have to "support" their colleagues and have to rest.
After a busy morning, the medical staff had a simple meal.
Gao is obviously an "old hand" in dealing with critically ill patients.
When the epidemic broke out in 2020, he became the third batch of medical staff from the Affiliated Hospital of Qingda University to help Hubei, and was stationed in the intensive care unit of tongji hospital affiliated to Tongji Medical College of Wuhan Huazhong University of Science and Technology. Later, he was stationed in the hospital isolation ward and Qingdao emergency standby hospital and designated hospital many times.
"At the time of all infections, some colleagues were actually ordinary pneumonia patients, but they persisted. We insist that most critically ill patients have received timely and appropriate treatment. " Gao Jilong said.
"High-flow oxygen inhalation, ball bag mask ..."
Always ready to "rob people" with death.
The numbers on the ECG monitor are of great significance to life and death, and calmness is a kind of safety.
Liang Shan and his team are most afraid of hearing the "Tintin" sound on the monitor. Once it rings, it means that the rescue has begun.
When the condition of the elderly changes, doctors and nurses will respond at the first time.
An elderly patient was extremely hypoxic, and it was difficult to maintain oxygen in his body by spontaneous breathing. Liang Shan immediately put on a mask and gloves, and together with the medical staff present, inserted the laryngoscope into the patient's trachea, and then fixed the position of the throat.
In the interval of tens of seconds, the patient's face turned red due to lack of oxygen, his chest bulged high and his throat made a sharp gasp. At the moment when the ventilator was connected to the throat, the patient lay on his back in the hospital bed and his face finally recovered.
"Invasive tracheal intubation is to extinguish his spontaneous breathing and completely ventilate oxygen through the instrument. The main symptom of COVID-19's syndrome is dyspnea, and many lungs have turned white. We must give him enough oxygen when we come up. " Liang Shan told reporters.
Patient Mr. Hou, 80 years old, suffers from severe diabetes. "Because of diabetes, his blood sugar rose very high, and acidosis and ketosis appeared in his urine. At present, we mainly correct his ketosis. "
Liang Shan said that because the patient had a high fever of 39 degrees Celsius, he received CRT treatment to correct his ketosis. After a night of infusion, his temperature has dropped to above 36 degrees Celsius.
"Some people with diabetes may not necessarily show prominent pneumonia at first, but may also show complications, such as disturbance of consciousness, severe electrolyte disorder and metabolic acidosis. There are also some patients who have aggravated heart failure due to infection, inducing serious myocardial ischemia events and even myocardial infarction. " Liang Shan said.
Patient Mr. Lin, 78 years old. Because he had a heart bypass surgery before, his lungs also had inflammation. After being infected with COVID-19 virus, his lung function deteriorated due to severe hypoxia. After that, Mr. Lin's symptoms became more and more serious, and he finally entered the ICU.
"Push another 5mg of midazolam" and "The airway pressure is too high". Standing in front of the hospital bed, Liang Shan is like an anchor needle.
The patient's family is at the door of ICU, anxiously asking about the old man's condition.
For him, such emergencies often occur, such as decreased oxygen saturation, respiratory failure, cardiac arrest, tracheal intubation, connection of ventilator, cardiopulmonary resuscitation, and every crisis has its own means to deal with.
In just a few minutes, a person may live from birth to death, or he may be pulled back from the door of death by the battle-hardened ICU medical staff.
"The elderly over the age of 80 in the ward account for one third. All the signs of the elderly may change at any time, so be careful. " Liang Shan said.
Patients never cooperate.
"prone position" ventilation can effectively improve blood oxygen
In order to meet critically ill patients, the affiliated hospital of Qingda University has prepared many critically ill beds. After the patient is transferred out, new critically ill patients will be admitted immediately, and each intensive care unit is always operating at full capacity.
"Looking at the ICU now, the patients are still relatively calm and orderly, and every medical staff is supporting them." While speaking, Liang Shan and his colleagues are carrying out "prone position ventilation" for an 84-year-old patient.
The bedside is slightly raised, and the patient leans against the bedside with a U-shaped pillow on his chest. "Let's lie down as long as possible. Prone ventilation is very important. It can promote the drainage of airway secretions, improve the oxygenation of patients, and reduce the compression of the mediastinum and the heart on the lungs. " Liang Shan said.
Sometimes patients don't cooperate because of physical discomfort. Some patients feel that it is hard to sit and gasp, and it will be even worse to lie down. At this time, the head nurse Gao Jilong will patiently persuade the old man to sit by the bed and lie on the bedding raised by the bed. A few hours later, his oxygen saturation increased from 88% to 97%, and his breathing improved significantly.
After the medical staff ventilated the elderly in prone position, the blood oxygen of the elderly was obviously improved.
According to Gao, prone position ventilation is "lying down" to treat diseases. Through turning-over bed, turning-over device or manual turning-over with bare hands, the patient can breathe in prone position or be ventilated mechanically, which can effectively improve the oxygen saturation of the patient, and can also effectively improve the lung ventilation/blood flow ratio, so as to expand the collapsed alveoli in the back, and the secretions of the lungs and trachea can be well drained under the action of gravity, thus reducing the pressure of the heart and mediastinum on the drooping lung area.
"There are many people who have difficulty breathing after Yang, and they are becoming more and more popular. Some patients can improve blood oxygen and increase blood oxygen saturation through this posture. " Gao Jilong said.
After the arrival of COVID-19, the affiliated hospital of Qingda University is also stepping up training to ensure that more medical staff have the ability of intensive care. According to the requirements of the superior documents, the affiliated hospital of Qingda University will carry out the training of novel coronavirus infection diagnosis and treatment plan. The training content includes novel coronavirus infection diagnosis and treatment scheme and novel coronavirus infection diagnosis and treatment scheme.
"Severe patients and tide wait for no man. We can only try our best to overcome the difficulties and support it again. Although it is difficult to defend, every time a patient is rescued, the medical staff are gratified even though they are very tired. This is both the responsibility of doctors and the mission of doctors. " Liang Shan told reporters.
● According to all-media reporter Qi of the peninsula.