In the First Affiliated Hospital of Xi'an Jiaotong University, there is such a young epidemic team, who fight in the intensive care unit day and night, relaying tug-of-war with the god of death, and trying to open the door of life for the troubled patients.
support
The Eighth Hospital of Xi'an City, as a designated hospital for the treatment of new crown pneumonia patients at the two levels in Shaanxi Province and Xi'an City, began to treat patients diagnosed with new crown pneumonia as early as the current round of epidemic in Xi'an.
In late November, due to the critical illness of one of the seriously ill patients admitted and the continuous progress of the condition, the government urgently coordinated with the medical staff of the First Affiliated Hospital of Jiaotong University to rush to the eighth hospital.
Deng Chao (Attending Physician of Cardiovascular Surgery): After receiving the notice from the hospital, I didn't think much about it, and immediately packed my bags and left. After entering the eighth hospital, the first task is to learn various epidemic prevention measures and requirements to avoid infection in the hospital. The epidemic prevention measures of the Eighth Hospital are very strict, which plays a very important role in protecting medical staff and patients.
Deng Chao is a core member of the ECMO team of the Department of Cardiac Surgery of the First Affiliated Hospital of Jiaotong University, a young but experienced specialist in the field of cardiovascular patient treatment. In the epidemic situation in 2020, as a backbone, he participated in the treatment of the most critically ill new crown pneumonia patient in Shaanxi Province at that time, the patient ECMO operated for 49 days, he ate and lived in the ward for dozens of days, and handled countless dangerous situations until the patient recovered and was discharged from the hospital.
Zhao Xuan (Nurse of the Intensive Care Department): I received a call from the head nurse Han Juan to ask for support, and without hesitation, I went to the Eighth Hospital after meeting with my colleagues. In the Eighth Hospital, I also met Professor Zhu Bai of the Respiratory Department and Professor Liu Yu of our Department, who had been working in the Eighth Hospital for a period of time and introduced us to the patient's situation. One of the critically ill patients was in a relatively stable condition, and after a noninvasive ventilator and high-flow oxygen therapy, there was no intubation. The other patient was different, and when we saw that she was full of tubes and was in a critical condition, we were all more anxious. ”
Treatment
Critically ill patient is an elderly woman, many underlying diseases, autoimmune diseases, lung lesions are more serious, ECMO 62 days, is currently the longest time on ECMO in Shaanxi Province, a total of 4 times to change the membrane lung.
Guo Fengwei (attending physician of cardiovascular surgery): I and Dr. Deng Chao and Dr. Guo Litao serve as the clinical frontline, participating in the daily specific treatment plan of this patient, six doctors work in shifts, always leaving, staying in front of the patient, what problems are dealt with at any time, and if there is any urgent problem, they will report to the superior or provincial experts. In addition to basic treatment, he is also responsible for the maintenance and replacement of ECMO, including the handling of all emergencies in ecmo's treatment process and the adjustment of ECMO-related treatment regimens.
[During Insertion into ECMO]
ECMO, or extracorporeal cardiopulmonary system, is a first aid device that combines respiratory and circulatory aids, and is also a new cardiopulmonary support technology that maintains oxygenation and blood supply to human organ tissues. This world-class life support technology represents the level of acute critical care in a hospital, a region or even a country. In 2020 alone, the ECMO team of the First Affiliated Hospital of Jiaotong University saved more than 100 lives, ranking first in the province.
The patient's condition is really critical and complex, in addition to ECOM, there are also PICC catheters, tracheal intubation, urinary tubes, nutrition tubes, etc., more pipelines, the risk of infection is larger. On the ventilator, it is necessary to do oral care to ensure oral hygiene, but because of intubation, each time it takes 2-3 people to cooperate together to complete, and the usual familiar action is clumsy because of the heavy protective equipment.
Guo Jing (Nurse in charge of the Department of Critical Care Medicine): There are many tubes on the patient's body (trans-enceotracheal intubation, nutrition tube, radial artery catheterization, PICC catheter, chest drainage tube, urinary catheter, ECMO tube, stool manager), in order to improve the lung condition, it is necessary to change from supine position to prone position, and the most worrying thing about the whole process is the de-tube when turning over. We thought of a good way to use the bed sheets under the patient to achieve the effect of safe turning over, the whole process is not out of the tube, and the parents breathe out.
Fu Rong (Nurse of the Department of Respiratory and Critical Care Medicine): As the condition worsened, the patient was unable to eat, and in order to ensure nutrition and prevent aspiration caused by the prone position, it was decided to leave her with a nasal tube. Where the position of the nasal andintestinal tubes is, the operator's experience and feel are all evaluated. We wore two pairs of gloves at the time, which felt particularly bad and failed. Try to do it under gastroscopy guidance, and the result is sent to the stomach at most, and it cannot be indwelled into the duodenum. Chief nurse Mou Chunying did not give up, repeatedly kept looking for feelings, after about two or three hours, it felt okay, the film was taken to determine the position just right, the tip of the nasal andintestinal tube was falling on the duodenum, the tube was very beautiful, there was no bending and discounting, and all of us admired her very much!
critical
Patients have twice experienced major airway bleeding, under normal circumstances, it is difficult for patients to survive, but under the leadership of Shi Qindong, the leader of the expert treatment team (director of the Department of Critical Care Medicine of the First Affiliated Hospital of Jiaotong University) and Liu Yu (professor of the Department of Critical Care Medicine of the First Affiliated Hospital of Jiaotong University), the youth epidemic team has created a miracle.
Deng Chao (attending physician of cardiovascular surgery): On the evening of November 30, the patient had an emergency, airway bleeding, a large amount of blood filled both lungs, and the patient could no longer breathe. At that time, it was decided to immediately clamp the endotracheal intubation and temporarily stop lung work. At this time, all the oxygen of the patient is provided by ECMO, which is the most dangerous moment in the entire treatment process, and any problems with ECMO will lead to the death of the patient.
Guo Fengwei (attending physician of cardiovascular surgery): After the patient has major airway bleeding, he immediately flips over from the original prone position and uses methods such as rehydration, blood transfusion, and airway epinephrine drops to stop the bleeding. Director Shi led everyone to work together, gave the patient two interventions, bronchial artery embolization, tracheal clamping, and then slowly stopped the bleeding of the airway. After stopping, every day A little bit of digging, only to pull out the blood clot inside, repeatedly. Finally, the patient's tidal volume gradually increased from the original 10 ml to 300 to 500, all the way back to the state before the bleeding.
Zhao Xuan (nurse of the Department of Critical Care Medicine): After the expert group's research and judgment, to completely stop the bleeding, it is necessary to do bronchial artery embolization interventional treatment. To perform this operation, the patient needs to be transferred from the intensive care unit to the CT room for examination, and then transferred to the interventional operating room for surgery. The whole process is very anxious, because the patient is full of pipes, but also with pumps and machines, various power lines, there are steps along the way, more than a dozen people carry the bed, take liquids, help the pipe, very hard, before and after spending 6-7 hours, back and forth is already two or three o'clock in the morning.
On 3 December, the patient's airway was bleeding again and he decided to go out again for blocking and CT examinations, this time from 3 p.m. to 1 a.m., sealing the bronchial artery. For the following month, the tracheoscopy was used every day to remove blood clots and sputum, daily prone position therapy, anti-infection, and adjustment of the treatment process of ventilators.
Wang Minna (Nurse In Charge of the Department of Critical Care): When the patient was bleeding, Professor Liu Yu came to the ward at 3 a.m. and came out at 6 p.m. the next day. When the condition is unstable, he can stay in the ward for a day and not come out, sticking to it, in fact, we ICU patients are guarded.
Director Shi Qindong always said a word: It is not because there is hope that we insist, but because we persist that there is hope.
lament
After a period of treatment, the patient has turned nucleic acid negative, no longer a critically ill patient of the new crown, but an ordinary critically ill patient. On the morning of January 13, 2022, according to the requirements of the superior, the patient needs to be transferred from the Eighth Hospital to the First Affiliated Hospital of Jiaotong University. After careful deployment, the reception process, path, and killing plan are formulated, and with the full cooperation of various departments and departments, the patient is safely sent to the negative pressure ward of the surgical intensive care unit, where further treatment will be received in the future.
Our youth epidemic team is still fighting!
Deng Chao (attending physician of cardiovascular surgery): Doctors are also human, and they will also have psychological pressure and anxiety in the face of seriously ill patients. I have been working for nearly two months since I received the support notice, and I am very lonely and miss my family and colleagues. Considering the continuity of patient treatment, after returning from the eighth hospital, it is seamless to continue to manage patients in the surgical ICU. It's very tiring, but the patient needs our dedication and input, and I will do my best, just hoping that the epidemic will soon end and everyone can return to normal work.
Guo Fengwei (Attending Physician of Cardiovascular Surgery): During the patient's entire treatment process, everyone went from hope to freezing point, and then from freezing point to hope, and their hearts rose and fell with the disease. The State Guidance Group, the Provincial and Municipal Health Commissions, the Eighth People's Procuratorate, and our First Affiliated Hospital in the rear area have always given great support. The equipment, drugs, and personnel needed by patients are mobilized from all over the province in the shortest possible time, just to treat patients as much as possible. As a doctor, as long as there is a glimmer of hope, I will do my best. If we hand over one person, we will only move forward, never backwards.
Wang Minna (nurse in charge of the Department of Critical Care Medicine): So long continuous daily work, to be honest, quite tired, away for more than 50 days, very much miss the child, the child also wants the mother, but there is no way, everything is patient-oriented, this is the basic professional ethics of medical staff.
Guo Jing (Nurse in Charge of the Department of Critical Care): Back in my hospital, my psychology was suddenly very solid. It will take time for the new nursing team to familiarize ourselves with the patient's situation, and we are most familiar with the patient's situation, and we will definitely continue to fight for the sake of the patient's subsequent treatment. If I want to say what I feel, I think it is to do my job, stand on the post where I should stand, and guard the people I need to protect, there is nothing remarkable. Jiaoyi caregivers do not change their original intentions, and the mission will be achieved.
Fu Rong (Nurse of The Department of Respiratory and Critical Care Medicine): Thanks to the strong backing of the First Affiliated Hospital, everyone rushed forward without worries. In the team supporting the eighth hospital, only we had a standard suitcase, which was as small as hand cream, washbasin and even the girls' physiological supplies, and from time to time there were food and fruits and other supplies. When the weather became cold, the hospital immediately organized personnel to send thickened and fleece autumn clothes and autumn pants, which was very intimate and touching. We know the patient's condition best, and we will stick to it, hoping to create miracles under our careful treatment and care.
Zhao Xuan (nurse of the Department of Critical Care Medicine): This war "epidemic", summed up in two words is "strength"! The strength of the team - even if it is late at night when the snow is falling, even if it is fighting until the early hours of the morning, even if it is the first cooperation between comrades-in-arms, no one has ever complained, no one has been left behind! The power of growth - as a post-80s me, the impression of the post-90s is still some children who have not grown up, but this time, whether it is the nursing of seriously ill patients, whether it is the on-call when working overtime, or the response when you need physical assistance, these "back waves" use actions to prove that they speak with facts, and they also completely change my impression of the post-90s!
Special thanks to Dr. Guo Litao of the Department of Critical Care Medicine, after returning to the hospital after completing the support mission of the eighth hospital, and then went to the intensive care unit of the chest hospital for support, I really did not have time to accept the interview, I wish you all the best and take care of yourself.
These young medical staff are only the epitome of many outstanding young people in the First Affiliated Hospital, in them, you can see many advantages such as hard work, dedication, professionalism, meticulousness, and love, and it is with these outstanding young people that the cause of the First Affiliated Hospital can continue to develop and continuously climb the peak.
Professor Lian Jianqi, head of the Shaanxi Provincial Intensive Care Expert Group, said: Work hard to move yourself, and work hard to the point of powerlessness!
That's what you did.
Thank you and hats off to you and all the medical staff!
Wen | Wang Rui