On the 23rd, the reporter walked into the ICU (Intensive Care Ward) ward of the southern branch of Renji Hospital (designated hospital) affiliated to Shanghai Jiao Tong University School of Medicine, and the beds were neatly arranged, and the critically ill patients in the ward were mainly elderly. The monitoring and treatment instruments at the head of the bed emit a "beep" sound from time to time, monitoring the patient's vital signs at all times.
Healthcare workers are caring for patients in the ICU ward. (Courtesy of the interviewee)
Inside the workstation, fully armed doctors and nurses in protective clothing are busy: recording patient information, answering work calls, preparing medicines, sorting out instruments; checking patients' vital signs, adjusting ventilator parameters; helping patients adapt to breathing in prone positions, turning over, checking and adjusting the speed of rehydration, recording patient temperatures...
At 14:00, Gao Yuan, director of the Department of Critical Care Medicine of Renji Hospital affiliated to Shanghai Jiao Tong University School of Medicine, took off his sweat-soaked protective clothing and appeared in the conference room on time, together with the directors of the Department of Infection and the Department of Respiratory Medicine.
The picture shows a number of experts working together for online consultation. (Photo by Xinhua News Agency reporter Zhou Lin)
Here, online consultations are held every afternoon. Doctors in designated hospitals and experts from mother hospitals discuss the diagnosis and treatment plans of seriously ill patients in the hospital one by one, and accurately formulate "one person, one policy".
The patient discussed on the 23rd was in a complex condition, suffering from mental illness, sudden acute myelitis, rhabdomyolysis, liver and kidney dysfunction, and gastrointestinal bleeding in the later stage, but the clinical symptoms of the new crown were mild, and CT showed a little lung exudation. After intense discussions, the directors of more than a dozen departments worked together to develop a new strategy.
"From the perspective of severe treatment, the incidence of severe and critical new crown pneumonia induced by the Aumicron virus strain is low compared with the previous virus strain. However, Omiljung is highly contagious, especially in patients with underlying diseases, the condition will be aggravated after infection, and the number of such patients is large, and the underlying diseases have different characteristics, bringing about the complexity of treatment. Gao Yuan said that on the one hand, the treatment of new crown pneumonia is being carried out in accordance with the ninth version of the diagnosis and treatment plan; on the other hand, the multidisciplinary diagnosis and treatment model (MDT) is used to discuss complex diseases and form a more accurate treatment plan.
A corner of the ICU ward of the southern branch of Renji Hospital. (Courtesy of the interviewee)
Renjinan Hospital received a notice on April 3 to change to a designated hospital, and officially admitted patients at noon on April 7, mainly for children, hemodialysis, pregnant women and adult COVID-19 patients with comorbidities.
"In order to make the best use of resources, our construction of the intensive care unit has always been based on the principles of setting up the ward, allocating the staff, and treating patients." Wang Zheng, vice president of Renji Hospital affiliated to Shanghai Jiao Tong University School of Medicine, said that ICU is the "main battlefield" for the treatment of critically ill patients with new crown, with more than 50 beds for severe illness, and the oldest age among the rescued elderly is 97 years old; in addition, there are more than 480 pediatric beds. "The diagnosis and treatment of basic diseases is still in accordance with the setting of specialization, and we try to restore the previous discipline structure of designated hospitals, so that the right doctors can see the right patients and exert the maximum potential of limited strength."
At 14:30, Wang Zheng had just finished lunch. He told reporters that clinical resources are currently in short supply. The hospital has approved 600 beds, and the current construction target is 892 beds, which is to operate at about 150% efficiency. "The venue and manpower are fully exploited, and the medical staff hardly take turns, so the space for further maneuvering is quite limited."
Medical staff are discussing at the ICU ward workstation. (Courtesy of the interviewee)
Wang Xingpeng, director of the Development Center of Shanghai Shenkang Hospital, said that among the seriously ill patients admitted in this round, there are two characteristics: one is that the proportion of elderly patients is relatively high, and at present, among patients in municipal designated hospitals, the proportion of elderly people over 70 years old is nearly 30%; second, the proportion of patients with combined underlying diseases is relatively high, more than 60%, of which 40% of patients with more than 3 basic diseases are combined.
Shanghai adheres to the three principles of paying equal attention to prevention of mild to severe and severe treatment, equal emphasis on the treatment of new crown and basic diseases, and equal emphasis on the treatment of traditional Chinese and Western medicine, bringing together more than 360 critical medical experts with rich experience in clinical diagnosis and treatment in the city, plus experts supported by other provinces and cities, and has set up 9 critical care teams, stationed in 8 municipal designated hospitals, and implemented centralized management and comprehensive treatment for patients with severe and critical diseases of severe and critical diseases of the new crown, critical illness and new crown positive.
Gao Yuan said that once the control of the epidemic is relaxed, the virus will spread widely, and a large number of severe diseases will appear, which in turn will run the medical system and form a vicious circle.
"Now the cumulative number of infected people in Shanghai has exceeded 450,000, of which the elderly have increased, the elderly superimposed on basic diseases, and the vaccination rate is low, which puts their lives and health at great risk." Gao Yuan said that accelerating "dynamic zeroing" is the greatest protection for elderly patients with underlying diseases. (Reporters Zhou Lin and Yuan Quan)
Edited by Yanting Chen