"More than 30 years in medicine, I've been in the emergency department for more than 20 years, and this has really never happened before!"
Being "the first person responsible for your own health"
On December 29, 2022, 1,971 people were seen in the emergency departments of Qingchun and Qiantang hospitals, and 143 were sent to the resuscitation room for resuscitation;
On December 30, 2022, 2,219 people were seen in the emergency departments of Qingchun and Qiantang hospitals, and 2,219 were sent to the resuscitation room for resuscitation. people, 131 people were sent to the resuscitation room for rescue;
On December 31, 2022, Qingchun and Qiantang hospital districts received 2,450 people for emergency treatment, and 134 people were sent to the resuscitation room for rescue;
On January 1, 2023, Qingchun and Qiantang hospital districts received 1,924 people for emergency treatment, and 119 people were sent to the resuscitation room for rescue
This is the last four days, Zhejiang University School of Medicine Shaw Hospital and Zhejiang University School of Medicine in the last four days.
Hong Yucai, director of the emergency department, described the situation as "unprecedented". "After more than 30 years in medicine, I've spent more than 20 years in emergency medicine, and this kind of situation, it's really never happened before." Hong Yucai said the hospital's emergency workload is currently more than three times its historical peak. About a week ago, the number of daily visits to the emergency room began to climb rapidly, and during this time, the total number of emergencies in the two hospital districts and the total number of patients rescued in the emergency room increased by 218 percent and 240 percent, respectively, and these figures continue to be refreshed.
"It is indeed very challenging for us." Hong Yucai confessed.
Among the critically ill patients
80% are elderly people over 80 years old accounted for a large proportion
There are not a few severe pneumonia
The number of emergency room visits has been on the rise, most of which are for minor illnesses, but it has to be noted that the number of critically ill patients is showing a growing trend.
"In the past, although the emergency room is also dominated by the elderly, but now the proportion is growing. Most of the elderly are accompanied by hypertension, diabetes, coronary heart disease and other underlying diseases, so often they are sent in a very critical situation, with confusion, low blood oxygen, and even respiratory failure and multiple organ damage, requiring immediate resuscitation." Hong Yucai said that 80 percent of the critically ill patients admitted to the hospital are elderly people, with a larger proportion above the age of 80.
And among these critically ill patients, there are few cases of severe pneumonia, with massive exudation from the lungs.
Some emergency physicians have done 10 cases of tracheal intubation in one night
93-year-old woman in a state of consciousness chose to give up
For many critically ill patients in critical condition, tracheal intubation is the first problem in front of them.
"Endotracheal intubation means that the patient is facing respiratory failure and needs to open the airway urgently, with the help of a ventilator to assist breathing. Most patients with severe pneumonia are in need of tracheal intubation." Emergency department doctor He Shunpeng introduced, tracheal intubation requires doctors, nurses, respiratory division of the three parties highly close cooperation, for this operation, emergency medical care are no strangers, but this recent period of time is also the same encountered new difficulties.
"Before endotracheal intubation, we will first carry out balloon ventilation on the patient, so that oxygenation reaches 100%, to maintain in a better state, because in the intubation operation the patient is not able to breathe oxygen. In recent times, the critical pneumonia patients were originally in very poor oxygenation, even with balloon ventilation, oxygenation could only reach 90% at most, which means that the time left for us to intubate is very short, and if we can't finish it quickly, the patient's risk will be one more point. Therefore, a high degree of medical and nursing mental concentration is required, and although the intubation process is not a short one, it is indeed not easy."
He Shunpeng said that if it were before, on average, he would encounter 2-3 cases a month that required tracheal intubation, while today, there are 3-4 cases every day. "Yesterday, I even heard from a colleague that he did 10 cases of tracheal intubation in one night the day before yesterday."
Tracheal intubation is not easy for the medical staff, and even more so for the patients themselves and their families.
Whenever he needs to talk to a family member before tracheal intubation, He Shunpeng tries to make all aspects clear, with the choice resting on the patient's side. "In the face of young patients, we will be more positive and try to advise the patient's family to fight for more, while many families of 80- and 90-year-olds will eventually choose to give up tracheal intubation simply because they do not want the old man to suffer more, and we understand that."
"Today I came across a 93-year-old woman whose daughter wanted tracheal intubation, but the son thought he should follow his mother's opinion. The old lady was conscious despite her respiratory distress and in the end she calmly gave up."
"Giving up tracheal intubation means that the patient can only rely on a pure oxygen mask to maintain oxygenation, which is definitely far less effective than intubation, but we also hope that the patient can pull through at minimal cost." He Shunpeng said that at such times, emergency physicians can only provide advice, the choice is in the patient himself and his family. And no matter what they choose, doctors will do their best.
Hospitals allow employees to take sick leave
But none of them have come to me for leave
"It's almost like not eating, not drinking, not going to the bathroom, and it's about to 'become immortal'." Hong Yucai joked about the recent state of work in the emergency room, with a few coughs mixed in with his laughter.
For the "Yang" on the post to insist on this matter, he is not willing to say more. "There is nothing to say, is too normal, every one of our colleagues are so, and now everyone has 'Yang Kang', across that hurdle!" On their own is "normal", but the words turn, Hong Yu only heartbroken colleagues in the emergency room.
"We have colleagues burned to 39.7 ℃, a splitting headache, hard to say that you can insist on eating to understand the heat analgesic medicine, and even did not have time to wait for the heat to come down, continue to insist on work; there are several colleagues to look at the state is really not right, so that they go back to rest for a while is also hard not to go, said, 'I'm gone no one to take over, the rest of the people! The hospital allows employees to take sick leave, but up to now there is no one to find me to take time off We always tell people around us to take more rest after the sun, but they are all in the 'way back'."
Family with elderly children Yang fever
are more or less anxious
"I am considered to be in the department 'Yang' later, more than 30 doctors, I am probably the twenty-fifth six it." Last Friday night after work, He Shunpeng appeared chills fever symptoms, fever to 39 ℃, the next day antigen shows positive, but he went to work as usual. "Into the work state, certainly to be fully committed. I am mainly responsible for the work of the resuscitation room, even more can not be sloppy." So busy that there is no time to stop and rest, but those days, He Shunpeng heart still remembered one thing, inevitably some anxiety.
"My child in my Yang the next day also had a fever, only 1.5 years old, less than the age of no vaccination, high fever burned to 40 ℃." Parents, think will have the same feeling, their own difficult are not a thing, in the end or rest assured that the child. "When talking to colleagues, as long as there is a child, will be because the child 'Yang' and more or less some anxiety."
It is a great hero who rushes in the front line in the face of the virus, but also the same is no more than ordinary ordinary people.
Ambulances seventy to eighty trips a day is the norm
Resuscitation room beds increased to 30
Still very nervous
Emergency department doctor He Yang said the previous emergency, ambulances every day about a dozen trips, and now seventy to eighty trips a day is the norm, and sometimes even three or four cars arrive together.
"After being sent to the emergency room, after symptomatic treatment, patients need to be triaged as soon as possible to the wards of various departments or ICUs.Under normal circumstances, the beds in our resuscitation room are 18, then increased to 25, and then increased to 30, or very tense, and need the cooperation of all aspects of the rapid diversion, in order to ensure the normal functioning of. "
He Yang believes that the work of the emergency room is "urgent and simple", "urgent" since needless to say, "simple" purpose only one
The first time I've ever seen a man in the world, I've seen him in the world.
"This time I am responsible for the rescue room area, so the patients are more urgent. I've been told by my colleagues in the emergency room that I occasionally come across patients who come to the emergency room and ask for a bill just because they have a cough or a low-grade fever and want to take a CT scan. It's true that some people will have tiny signs of inflammation in their lungs after a CT, but the situation is very mild." With limited medical resources, it is the elderly and those with underlying medical conditions that need more attention. "It is hoped that patients with mild conditions can choose general outpatient clinics or nearby community hospitals for medical care, leaving valuable emergency resources for patients who are truly in need."
All-out efforts to "collect and treat as much as possible"
A new ICU ward with 38 beds was opened on New Year's Day
On the one hand, the number of critically ill patients has been increasing, and on the other hand, emergency and ICU resources are limited, which has posed a considerable challenge to the rescue and treatment work.
Dai Sheng, medical director of Run Run Shaw Hospital affiliated with Zhejiang University School of Medicine, mentioned that the hospital has actively expanded the space of the emergency and rescue room by vacating and increasing the emergency triage area, expanding the emergency clinic area, setting up respiratory emergencies, the overall takeover of the general practitioner, expanding the infusion room, expanding the space of the rescue room, and setting up a special dispensing room for the simple fever clinic and other initiatives, which has effectively alleviated the phenomenon of long queues at the emergency clinic, and made the rescue work more effective and more effective. The phenomenon of long queues in the emergency room has been effectively alleviated, so that the emergency rescue is carried out in an orderly manner.
Currently, the hospital is actively implementing the requirements of "health protection, prevention of serious illness", the two hospital districts are set up 8 new crown critical care wards, *** counting 667 beds, rapid treatment of patients with new crown pneumonia, respiratory and critical care medicine is responsible for, according to the form of mixing of 10 doctors and 1 group, the two hospital districts *** set up 8 echelons staff, standardized management, give full play to the advantages of the profession, and the standardization of management, the professional advantages of the hospital. , standardized management, give full play to the advantages of the specialty, minimize the transition to severe as well as critical care ratio.
According to the requirements of the National Health Commission, tertiary hospitals comprehensive ICU to reach the proportion of 4% of the total number of beds, according to the proportion of 4% of the total number of beds to transform convertible ICU beds. "The number of operating beds in our hospital is more than 3300, according to the regulations, ICU and convertible ICU up to more than 260 is enough. However, the hospital leadership attaches great importance to the rescue of critically ill patients, we want to find ways to increase the number of convertible ICU beds to 350, as much as possible, so that more critically ill patients receive timely treatment." Dai Sheng said.
Currently, the hospital has 137 ICU beds, with an initial set of 162 convertible ICU beds. The hospital uses a three-step system to open comprehensive ICU and convertible ICU beds in an orderly manner, at present, the existing ICU can no longer meet the admission and treatment requirements, is gradually increasing the convertible ICU, at any time according to the rescue of critical illnesses to make dynamic adjustments. 2022, December 31, the hospital opened a new ICU ward,**** there are 38 beds, has been put into use on January 1st. In addition, the hospital invasive, non-invasive ventilator and Highflow equipment is sufficient to meet the use of existing ICU beds, another new supplemental equipment will be in place in one to two weeks.
"Next, we will make every effort to do a good job in the rescue and treatment of critically ill patients, so as to do as much as possible, as much as possible, for the public to build a strong health line of defense." Dai Sheng said.