Xiao Wanjun, a 4-year-old Jilin girl, likes to sing and dance, loves smelly beauty, and always looks in the mirror.
On the 3rd day after her unfortunate death, her aunt put the 6 art photos taken by Xiao Wanjun before she died in the circle of friends, and the text made people cry: "Baby, why are you so disobedient, so cruelly leave these people who love you, and your aunt will think of you later..."
Because of acute laryngitis, Xiao Wanjun sought medical treatment at the Nong'an County People's Hospital in Changchun City, Jilin Province, on March 11, 2022, and left her parents and the family who loved her forever while waiting for the results of the nucleic acid test for the next step of treatment.
The emergency and critically ill patient rescue registration form of the emergency department of Nong'an County People's Hospital shows: "After questioning the family, the child is a laryngitis patient, has completed the hospitalization procedures, and became ill during the transition ward."
In Jilin Province, an area where the task of epidemic prevention and control is particularly arduous, Xiao Wanjun's life is frozen in this early spring.
According to the National Health Commission, at 0-24:00 on March 14, 31 provinces across the country reported 3507 new locally confirmed cases, including 3076 cases in Jilin Province; 1647 new cases of local asymptomatic infection, including 991 cases in Jilin Province.
From March 1 to 14, more than 15,000 cases of infection have been reported in this round of local outbreaks, affecting 28 provinces.
Jilin Province is undoubtedly one of the most serious storm eyes of the epidemic, as of 24:00 on March 14, the cumulative number of positive infections reported in Jilin City in this round of epidemic was 6418, of which 4079 were confirmed cases and 2339 were asymptomatic infected people. At present, the positive infection rate in Jilin City is close to two in 1,000, which means that nearly 2 out of every 1,000 residents of Jilin City are infected.
The medical certificate (inference) of death issued by the hospital shows that the direct cause of death of Xiao Wanjun was "respiratory and cardiac arrest", and the cause of the disease was "acute laryngitis".
"The laryngeal pharynx is the narrowest place above the trachea, so people often use the 'throat artery' to describe the narrowness of the road. In children, the larynx is narrowed, and when acute laryngitis occurs, the situation can easily become dangerous and laryngeal obstruction may occur, leading to death." Li Hongri, director of the Department of Acute and Critical Care Medicine at Beijing Kyoto Children's Hospital, said that acute laryngitis in young children occurs more often in winter and spring, and is a relatively dangerous and rapidly developing disease.
"In my nearly 20 years of pediatric experience, I have only seen 1 death from laryngitis." Li Hongri revealed to the health community that the fatality rate of laryngitis is very low, as long as the treatment is timely, the prognosis of the child is very good.
Since laryngitis is not a serious disease that can easily take away children's lives, why did Xiao Wanjun suffer from this misfortune? The family members of the children pointed the responsibility to the "hospital prevarication of medical treatment", believing that the receiving doctor mechanically implemented the epidemic prevention and control regulations, and the treatment of the child was not timely, resulting in a worsening of the condition.
According to the relevant person in charge of the Nong'an County People's Hospital who received the treatment, he revealed to the health community that after watching the surveillance video of the child's diagnosis and treatment, he believed that the time of the entire treatment process was "indeed too long". He said that the treatment materials of the children have been sealed, and he hopes to reconcile with the family through the People's Mediation Committee for Medical Disputes.
Pour in the last step before the needle
On March 8, Xiao Wanjun, who lived in a village in Longwang Township, Nong'an County, felt uncomfortable, her throat was a little itchy, and she was a little panting, so her mother, Ms. Jiang, took her daughter to the township clinic to see a doctor.
The doctor diagnosed that Xiao Wanjun suffered from laryngitis, gave anti-inflammatory injections on the same day, and did nebulization treatment. The next day, Xiao Wanjun went to the clinic again for atomization, but there was no injection.
On March 10, according to the Jilin Provincial Health Commission, at 0-24:00 on March 9, there were 165 new locally confirmed cases in the province, and 179 new local asymptomatic infected people in the province. That was the first time since the current round of local epidemic in Jilin Province that the daily increase in local confirmed cases in Jilin Province exceeded 100.
On March 10, due to the severity of the epidemic, the clinic received a notice that "it is impossible to receive treatment", so the doctor asked Xiao Wanjun's family to take her to the big hospital for treatment, and advised: "This disease is not serious, but you have to go quickly, if you delay, it is very dangerous."
On the afternoon of March 11, Xiao Wanjun's father, Mr. Liu, his mother Ms. Jiang, and Grandma Gong, took Xiao Wanjun and four people to the Nong'an County People's Hospital for treatment.
At 14:21 on the same day, after the family arrived at the hospital, they first hung up the pediatric emergency department. According to Ms. Jiang, the pediatrician diagnosed Xiao Wanjun with laryngitis, so he told the child and his family that the pediatric department of laryngitis could not be managed, and he had to go to the five senses department next door.
At 14:27, the family went to the department of otorhinolaryngology, and the doctor of the otorhinolaryngology also confirmed that the disease of the child was laryngitis. According to Ms. Gong, the doctor of the five senses did not propose diagnostic and treatment measures, and asked the child and his family to wait.
Ms. Jiang said that she and her family considered that her family lived in the countryside and was far from the hospital, and if the child's condition changed after he returned, it was too troublesome to toss back and forth during the epidemic, so she asked the doctor for hospitalization.
The doctor immediately agreed to the hospitalization and requested the nucleic acid test report of the child and the accompanying staff in accordance with the hospitalization regulations.
On March 9, Changchun City announced at the press conference on the prevention and control of the new crown pneumonia epidemic in changchun city in 2022 that from March 9 to 10, changchun city will conduct the first round of nucleic acid testing for all employees.
Therefore, Ms. Gong, her son and daughter-in-law had already done nucleic acid testing in Longwang Township, Nong'an County at about 17:00 on March 9, but as of the afternoon of March 11, they had checked the relevant pages through their mobile phones, showing that the test results had not yet been released.
Xiao Wanjun did not do nucleic acid testing. "Our rural children are too young to do nucleic acid, for fear that her throat will hurt and break." Ms. Gong explained.
The doctor requires 4 people to do nucleic acid testing, opened a test sheet, need to walk 5 or 6 minutes away from the hospital to do nucleic acid testing in a color steel room, 2 hours out of the results, nucleic acid testing costs 40 yuan / person.
According to a press release published in May 2020, the hospital is the first county-level hospital in Jilin Province to do nucleic acid testing. In order to reduce the patient's economic burden and waiting time, antibodies and nucleic acids, only choose one of them for testing, the result is negative can be admitted to the hospital, the fastest 50 minutes to produce results, and go to Changchun test can be reduced by 1-2 days. Other outpatients do not need nucleic acid testing.
At 14:45, Ms. Gong and her party entered the color steel room for testing, which ended at 14:57.
They went back to the Department of Facial Features on the 4th floor of the hospital, and the doctor prescribed a hospitalization slip, and the cause was written as laryngitis. According to Ms. Gong's recollection, the doctor also specially instructed at that time: after completing the procedures, you can go to the transition ward on the 3rd floor and wait for the results of the nucleic acid test.
According to the Notice on Further Improving the Prevention and Control of Infection in Medical Institutions under the Normalization of Epidemic Prevention and Control issued by the Comprehensive Group of the Joint Prevention and Control Mechanism of the New Crown Pneumonia Epidemic of the State Council, circular [2020] No. 269 of the Joint Prevention and Control Mechanism, the transitional ward is used to admit emergency patients who have no nucleic acid test results or to isolate and check suspicious hospitalized patients.
After paying the hospitalization fee, Ms. Gong and her party came to the 3rd floor of the hospital, but they were told that the transition wards were on the 1st floor, and the doctor on the 3rd floor asked Ms. Gong to ask the doctor who was seeing the doctor if the arrangement was wrong.
So Ms. Gong went to the 4th floor of the Department of Five Senses to ask the doctor, and was told that the transition ward was indeed on the 1st floor, and the doctor had said it wrong before.
At 15:28, Ms. Gong and others arrived at the transition ward on the 1st floor, and Xiao Wanjun was arranged in bed No. 8. According to Ms. Jiang's recollection, at this time, Xiao Wanjun had shown obvious signs of discomfort.
According to Ms. Gong's recollection, the family asked the nurse in the ward that because the child was uncomfortable, could he prescribe some medicine and injections to relieve the symptoms?
The nurse said that this was a transitional ward, that it was for adults to be injected, and that children had to go to the 4th floor.
The family had to go to the 4th floor again, find the doctor of the five senses who had seen the doctor before, and ask for an injection for the child.
According to Ms. Gong's recollection, the doctor said: Your nucleic acid report did not come out, and you had to go to the transition ward on the 1st floor for injections.
Back in the transition ward on the 1st floor, according to Ms. Gong's recollection, the nurse said that she did not know what medicine to give xiao wanjun, because this side was for adults to inject.
Xiao Wanjun still couldn't get an injection, so they had to take Xiao Wanjun up to the 4th floor to find a doctor with five senses. According to Ms. Gong's recollection, this time the doctor of the five senses agreed to give the child an injection, prescribed dexamethasone sodium phosphate injection and sodium chloride injection, and found a female doctor to dock.
According to Ms. Jiang's recollection, the female doctor comforted the family: she had said hello to the transition ward downstairs and hung bottles for the child, and after these two medicinal uses, the child's condition would get better and better. The doctor also instructed that when the hanging bottle was halfway hit, the child was carried to the 4th floor, and the two doctors examined it together to determine whether Xiao Wanjun was admitted to the pediatric department or hospitalized in the five senses ward.
The group returned to the transition ward again. When I was preparing to hit the hanging bottle, the doctor in the ward felt that the child was a little hot, so he took the temperature, 37.8 ° C.
According to Ms. Gong's recollection, the doctor said: You can't get an injection if you have a fever, you have to go to the fever clinic.
At this time, Xiao Wanjun was already very uncomfortable, and said to her mother, Ms. Jiang, "Mom, I am not feeling well, I don't want to leave."
When Ms. Gong saw the situation, she said to the doctor: Can you give the child an injection first, and a few of us adults will go to the fever clinic?
According to Ms. Jiang's recollection, the doctor said that according to the regulations, the child could not stay.
Therefore, Ms. Gong and Xiao Wanjun's father carried her to the fever clinic again. Along the way, Xiao Wanjun kept shouting, "Grandma, I'm uncomfortable, uncomfortable."
On the way to the fever clinic, pass through a small glass room, which is about 50 meters from the transition ward. Upon arrival at the glass room, the nurse asks for a temperature check. Ms. Gong said that she had previously taken her temperature in the transition ward, 37.8 ° C, could you give the child an injection first, the child was too uncomfortable.
According to Ms. Gong's recollection, the nurse said: Listen to you or listen to me? You have to go through the process. Nurses took temperatures and found that the girl's body temperature was still 37.8 °C.
"Acute laryngitis in young children is a dangerous and fast-growing disease. Some children have high fever, while others have a normal body temperature." Li Hongri analyzed this.
After taking the temperature, the nurse led Ms. Gong and her party through a small passage and entered the fever clinic from the back door.
Ms. Gong looked up and realized that the fever clinic was the color steel room where nucleic acid was done before.
According to Ms. Gong's recollection, after some communication with the fever clinic medical staff, the fever clinic doctor asked the family to take the child back to the transition ward for injections, and gave a signed and sealed instruction.
From the transition ward to the small glass room, to the fever clinic, and then back to the transition ward, the whole process takes about 15 minutes.
At 16:38, when they returned to the transition ward, Xiao Wanjun said to Ms. Jiang, "Mom, I want to drink water."
Ms. Jiang thought that her daughter had not yet hit the hanging bottle, so she said: Let's not drink water first.
Xiao Wanjun said, "Mom, I want to go to the toilet."
So Ms. Jiang carried her daughter to the toilet, and before her pants were finished, Xiao Wanjun suddenly lost her breath and her face turned pale.
Ms. Gong heard that the situation in the toilet was not right outside, rushed in, rushed to the hall with the child in her arms, and called the doctor for emergency treatment. It was 16:40.
According to the signed records, 8 medical personnel participated in the rescue. According to the emergency department emergency department emergency and critical patient rescue registration form, when sent to the emergency department from the transition ward, Xiao Wanjun was unconscious, had no spontaneous breathing, dilated bilateral pupils, cyanosis of the face and lips, no pulsation of carotid arteries, and pulse could not be detected. (Doctors) Consider the child's "breathing and heartbeat stop", immediately perform cardiopulmonary resuscitation, and urgently check the electrocardiogram, show an isoelectric line, establish intravenous access, and ask the pediatrician, the five senses doctor, and the operating room doctor to intubate.
At 16:50, the doctor announced that Xiao Wanjun had no vital signs and that "after consultation, the patient had died clinically".
Ms. Gong could not accept it, and when she continued to slap her back with her child, she heard two "grunting sounds" coming from the child's stomach, and found that Xiao Wanjun's facial cyanosis had decreased.
"Looking at your face, it's like a normal child sleeping." Ms. Gong recalled that she and her family asked the doctor to continue the rescue.
According to the emergency department emergency department emergency and critical patient rescue registration form, the five senses doctor for the child to do suction sputum treatment, the family request to continue the rescue, pediatrician, five senses doctor recommended to continue cardiac resuscitation, endotracheal intubation. The doctor considered that the child had died clinically, the medication was of little significance, and a large number of foreign bodies were found in the trachea during intubation, which was viscous and not easy to aspirate, and only a small amount of foreign bodies was extracted.
The doctor continued to perform cardiopulmonary resuscitation on the child, and after about 1 hour of rescue, the child still did not regain consciousness, did not breathe spontaneously, and the electrocardiogram showed an isostere. The doctor confessed the condition to the family, the child has died clinically, the family asked to abandon the treatment, and the rescue was completed.
At 17:46, the doctor announced xiao Wanjun's clinical death.
The medical certificate of death (inference) shows that the direct cause of death is "respiratory and cardiac arrest", the cause of the disease is "acute laryngitis", and the approximate interval between the onset of illness and death is "about 5 minutes".
Hospital duty leader: The treatment data of the child has been sealed, and it is hoped that the family will negotiate peace through the Medical Investigation Commission
Nong'an County People's Hospital has a history of 74 years and is located in Nong'an County, the hinterland of the Songliao Plain. The city of Nong'an County, known as HuanglongFu in history, was once the royal city of buyeo ancient kingdom, the important town of the three dynasties of Bohai and Liaojin, and was famous for the oath of the anti-Jin hero Yue Fei: "Straight to Huanglong Province, drink with the kings".
As a tertiary general hospital, in 2012 and 2014, Nong'an County People's Hospital was successively identified as a pilot hospital for medical reform at the provincial level and at the national level. It has established a medical consortium with the Second Hospital of Jilin University, Jilin Provincial Cancer Hospital, and China-Japan Friendship Hospital of Jilin University. In 2018, the hospital was identified as one of the 148 pilot hospitals in the country under the modern hospital management system... It can be seen that under the guidance of national policies and with the help of large tertiary hospitals, the capacity building of Nong'an County People's Hospital has been continuously strengthened, and the level of medical services has steadily improved, but the incident of "death of a girl with acute laryngitis" has exposed that there are still loopholes in the diagnosis and treatment process of the hospital.
"On the day of the incident, I was on duty, and after hearing the news of the girl's death, I immediately went to understand all aspects of the entire diagnosis and treatment process, including medical records, surveillance videos and other information, and handed them to the dean in charge of medical treatment and colleagues in the medical department the next day." On the day of the incident, a section chief of the local health department also came to the hospital to understand the situation." On March 14, Wang Xuedong, vice president of Nong'an County People's Hospital, told the health community.
The health community asked: "The patient's family reported that several doctors from different departments have been prevaricating this child, do you think it is possible that this kind of prevarication is really possible under the current situation that the epidemic prevention and control is very strict?"
"Yes." Wang Xuedong admitted that after he had seen the surveillance video of the child's diagnosis and treatment, he personally believed that the time of the entire treatment process was "indeed too long".
According to Wang Xuedong, because the epidemic situation is fierce, the five senses department basically does not accept patients, so it prescribes good medicines and lets the children go to the transition ward for injections, and because the children have fever, the transition ward does not dare to fight, and the children need to go to the fever clinic for nucleic acid testing first, and then come back to inject after the results come out.
"The hospital and the children's families have proposed two solutions, one is to mediate through the medical investigation committee, if there is an omission in the hospital's work, it is willing to bear the liability for compensation, and the other is to take the legal route, that is, the children's families go to the court to sue the hospital." Wang Xuedong introduced in a sincere tone.
"Clarifying the cause of the child's death is a prerequisite for mediation by the Medical Investigation Commission. In order to fully protect their own rights and interests, both doctors and patients should first conduct a cadaver examination of the girl to confirm the cause of the child's death, so as to further determine whether the doctor is responsible." Daniel Zhang, founder of the medical legal team of "Medical Law Exchange", told the health community.
Lawyer Daniel Zhang explained that the People's Mediation Committee for Medical Disputes (hereinafter referred to as the Medical Investigation Commission), as a third party, can entrust an appraisal agency to conduct a medical damage appraisal, analyze whether the medical party is at fault in the medical act, whether there is a causal relationship between the fault and the death of the child, and determine the specific degree of participation (causal force) of the original fault.
In addition, the Medical Investigation Commission does not have the power to force mediation, as long as either of the doctors and patients does not agree to mediation, mediation can not be carried out. During the mediation process, the Medical Investigation Commission can only apply for medical damage appraisal on behalf of the doctor and the patient with the consent of both doctors and patients.
"The child's autopsy is very necessary for both the doctor and the patient, and sometimes the patient refuses the autopsy for various reasons, and if the cause of death is unknown and the medical fault cannot be ascertained, the party who refuses the autopsy is responsible." Daniel Zhang lawyers put this particular emphasis.
Previously, he had represented a case that was identified as a delay in hospital treatment that led to the death of a laryngitis patient, in which the patient's family received more than 500,000 yuan in compensation.
Wang Xuedong said bluntly that taking the legal route takes a long time, the procedures are cumbersome, and there are many uncertainties, so the hospital hopes that the two sides can talk well and strive for the two sides to reach a settlement.
Wang Xuedong said that regardless of whether there is any negligence in the hospital's work, the death of the child is something that everyone does not want to happen after all, and the hospital is willing to actively communicate with the family of the child.
"Since the incident, the hospital has set aside a separate room for the four family members of the children to live in, and to cover three meals a day." Wang Xuedong revealed.
Wang Xuedong finally said that he was the vice president in charge of logistics and was not in charge of medical work, and the hospital's statement on the incident should be released by Wang Xingcai, vice president in charge of medical treatment.
Wang Xingcai told the health community that he was not on duty on the day of the incident, did not have a comprehensive understanding of the incident, and was holding a meeting on epidemic prevention and control.
Pediatrician: The principle of treatment should be "the child moves less, the doctor moves more"
"Children with severe illness cannot be left untreated because they do not have a nucleic acid test report, or be sent to a fever clinic." Li Hongri told the health community that epidemic prevention and control cannot be a reason for medical institutions to blame patients.
If the child is treated in a fever clinic, even if the nucleic acid test results have not yet come out, as long as the condition is serious, the doctor in the fever clinic should urgently invite doctors from ICU and other departments to participate in the emergency treatment. Li Hongri said, "In short, the principle is to let the children move less and the doctors move more."
Li Hongri said that the treatment of seriously ill children must take the "green channel". Specifically, during the normalization of epidemic prevention and control, if the child has serious trauma, shock, or acute laryngitis such as breath holding and hypoxia, the child will be treated in situ in the observation area, such as trauma to be bandaged, and if emergency intubation is required, it is necessary to intubate immediately.
Children who do not have a nucleic acid test will be treated in a separate isolation area in the observation room. At the same time, the nurse samples the child, conducts nucleic acid testing, and after the results are available, the child's family members go through the hospitalization procedures.
Li Hongri said that acute laryngitis in young children is a relatively dangerous and rapidly developing disease. Some children will have high fever, and some will always have normal body temperature, which is mainly manifested by dyspnea and wheezing. Since laryngitis is mostly caused by viral infections, the main treatment modalities are hormone and nebulization. If a blood test suggests a bacterial infection, antibiotic therapy is required.
"In children, the larynx is narrow, and when acute laryngitis occurs, the situation can easily become dangerous and laryngeal obstruction may occur, which can lead to death." Li Hongri introduced that therefore, when the child is treated with infusion, it is necessary for the family and the patrol doctor to strengthen observation to avoid accidents. And because laryngitis has symptoms of asthma, it is easy to confuse with laryngeal edema and airway foreign bodies caused by allergies, "which requires the receiving doctor to be vigilant and make accurate judgments on the cause in time."
"In my nearly 20 years of pediatric experience, I have only seen 1 death from laryngitis." Li Hongri revealed that the fatality rate of laryngitis is very low, as long as the treatment is timely, the prognosis of the children is very good.
Emergency Department Director: The patient's life comes first
Zhao Bin, director of the emergency department of Beijing Jishuitan Hospital, said in the special program "Very Connected" in the health industry that the emergency department does not treat patients according to disease classification, but according to the clinical symptoms of patients. Emergency department treatment involves cardiovascular, cerebrovascular, digestive tract, etc., if the patient has any discomfort from head to toe, you can go to the emergency department for help at the first time.
"In the eyes of emergency doctors, life comes first." Zhao Bin stressed that emergency department doctors should first pay attention to the criticality of the patient's situation, first let critically ill patients and potentially critically ill patients maintain stable vital signs, and then consider the next step of treatment. Regardless of whether there is an epidemic or not, the progress of critically ill patients admitted to the emergency department will not stop. Therefore, during the epidemic period, the emergency department must ensure the treatment of critical and serious diseases on the one hand, and at the same time, it is also necessary to do a good job in the prevention and control of infectious diseases in the hospital.
According to Zhao Bin, at present, Beijing Jishuitan Hospital will treat patients who are critically ill but do not have nucleic acid test certificates in accordance with the diagnosis and treatment methods of positive patients, and send them to a separate rescue room for rescue at the first time.
The doctors and nurses who receive the treatment diagnose and treat the patients under the protection of the third level. After diagnosis and treatment, wait for the nucleic acid result, or at this time to give the patient another nucleic acid, if the patient has a negative nucleic acid test, and then lift the relevant protective measures.
Zhao Bin believes that during the epidemic period, the emergency department and fever clinic of the hospital should be organically integrated and coordinated to avoid the situation of "blaming each other's patients" and delaying the treatment of patients.
(For the protection of minors, Xiao Wanjun is a pseudonym)
Source: Health Community
Author: Li Zijun Shen Mengxia
Producer: Zheng Yujun