"After 25 years of gastroscopy, it was the hardest and the longest." Talking about the emergency gastroscopic foreign body surgery two days ago, Su Lin, a pediatrician at Shanghai United Family Hospital, still seems to have some palpitations.
The author | Xiao Xiang
Source| Medical Community (ID: vistamed)
A thrilling emergency surgery
"After 25 years of gastroscopy, it was the hardest and the longest." Talking about the emergency gastroscopic foreign body surgery two days ago, Su Lin, a pediatrician at Shanghai United Family Hospital, still seems to have some palpitations.
At more than 9 p.m. on April 20, Su Lin received a call from a colleague at the hospital, it turned out that a 19-month-old child accidentally swallowed a magnetic foreign body, about 2.5 centimeters in diameter, vomiting and crying symptoms, and was urgently sent to the Shanghai United Family Emergency Department for medical examination, and the emergency doctor confirmed that the foreign body needed to be removed through gastroscopy. At that time, Surin was recuperating at home because of a fractured ankle bone, unable to drive, and the director of the anesthesia department of the hospital was working the night shift, so he went to pick up Surin and rushed to the hospital together.
After returning to the hospital at 10 o'clock, SuRin communicated with the child's family and began preoperative preparation, and at 11:15 began gastroscopy, because after the child swallowed the foreign body, the parents mistakenly thought that they could eat and swallow the foreign body, so they fed the child food. The food in the stomach led to limited visual field of operation, Surin and the surgical team spent two hours, repeatedly carried out saline irrigation, changed the child's position from the left side to the supine, and then converted to the right side of the bed, and operated the net pocket for fishing, during which the radiologist was also invited to take the bedside photograph, and finally saw the foreign body.
At 1:13 a.m., Surin operated the foreign body tongs to clamp the foreign body and very carefully removed it, while Surin, whose feet were still suffering from fractures, had also numbed his feet after a long standing.
Infants and young children swallow foreign bodies, for Su lin as a pediatrician is not uncommon, but after this emergency treatment, Su Lin still reminds parents, first of all, must not put small parts in the place where infants and young children are easy to touch; secondly, once swallowing foreign bodies, can not wait, go to the emergency department as soon as possible, do not eat to try to suppress it, it is likely to scratch the esophagus, or even cause perforation, will also increase the difficulty of treatment; after arriving at the hospital, you should also listen to the doctor's professional advice, if necessary, take a film as soon as possible, so as not to delay treatment.
The emergency department is non-stop, helping thousands of patients during the epidemic
"Before the parents of the children came to the hospital, they contacted me by phone to confirm that our hospital emergency department was open." Shanghai United Family Hospital emergency doctor Li Xiaoguang introduced that after receiving the child that night, the respiratory tract foreign body was excluded, but because of the magnetic nature, it may cause a lot of risk to the child, X-ray found that it has entered the stomach, and it is necessary to take advantage of the emergency gastroscopy when it is still in the stomach, "If you enter the small intestine through the stomach, the gastroscope will lose the opportunity, and you can only rely on surgery." ”
Li Xiaoguang introduced that since the epidemic, the emergency department of Shanghai United Family Hospital has been relatively smooth, and since March, the emergency department has helped thousands of patients solve the medical assistance needs in emergency situations. In this case, due to the relatively critical condition of the child, the hospital still chose emergency rescue in the case that the nucleic acid negative report could not be issued in time.
"For emergency departments, the grading system is very critical", Li Xiaoguang introduced, from the perspective of international conventions, emergency departments are generally divided into five levels, the first level of the situation is the most urgent, not immediate rescue may soon be life-threatening; the second level is a dangerous situation, need to allocate medical resources as soon as possible, may be 5 minutes patients will face life danger; the third level of the condition is relatively urgent, there may be half an hour of buffer time, but also need to be treated as soon as possible; and the fourth and fifth levels can not see the emergency department to see the outpatient clinic.
"In the case of the first and second degrees, there is no way to wait for nucleic acids, such as myocardial infarction to put a stent immediately", Li Xiaoguang said, in such a situation, Shanghai United Family's emergency response strategy is that doctors put on protective clothing, enter the negative pressure ward for emergency treatment, and receive treatment according to the protection level of positive patients. Since the air conditioning system in a separate negative pressure room is an internal circulation of air, the risk of infection can be reduced.
According to reports, in order to do a good job in the prevention and control of the epidemic in the hospital, the hospital has prepared 5 negative pressure consultation rooms, 7 negative pressure wards and 1 special operating room to prepare patients for emergency admission surgery. At the same time, it is equipped with an emergency passage that leads directly to the dedicated operating room and the consultation room, which is isolated from the ordinary medical area.
"Fortunately, there have been no positive cases at present, but the admission process is handled in this way, and the situation that requires emergency surgery cannot wait for nucleic acid reports." Li Xiaoguang said.
Medical treatment and epidemic prevention and control are two-front combat
Since the outbreak of the local epidemic in Shanghai in March, the epidemic situation has continued to be tense. According to Wan Lijun, chief medical officer of Shanghai United Family Hospital, unlike the epidemic prevention and control in early 2020, it was faced with the dilemma of lack of anti-epidemic materials, and this time due to the start of sealing and control management in many communities in the city, some medical care in the hospital was not known in advance and was sealed, and the personnel were affected to a certain extent. In order to ensure the normal operation of medical services, many medical staff have volunteered to stay in the hospital.
Wan Lijun introduced that before the epidemic, Shanghai United Family has begun to explore the operation of Internet hospitals, after the beginning of the epidemic, with the suspension of some hospital outpatient emergency departments, the longer the community closure time, some chronic disease patients in the community are inconvenient to travel, so the Internet hospital consultation has played a big role. Later, the demand for prescribing drugs increased, and the hospital launched the "Health Leader", a one-stop solution to the family health problems during the epidemic, with Wan Lijun as the "regiment leader" in Puxi District, experts from various departments, blood banks, operating rooms, drugs, etc. on standby for 24 hours, any emergency situation, with the strength of the whole hospital, coordinate the resources of all parties, and open a green medical channel for patients.
It is understood that as of April 21, Shanghai United Family Pudong Puxi two hospitals have delivered more than 760 drugs to patients, and the number of online consultations in the two hospitals in Pudong Puxi has totaled more than 3,700 times, covering more than 20 departments.
Not long ago, on the issue of the opening of hospital emergency departments during the epidemic, Wan Lijun accepted an interview with CGTN, he believes that at present, many communities are closed, and the hospital's medical resources are relatively tight, and it is not known which hospitals are open, nor do they know what diseases the hospital can see, how to find resources when sick, and this information asymmetry status quo also needs to be paid attention to and solved.
"Since the outbreak of the epidemic in 2020, Shanghai United Family Hospital has been operating 24 hours a day, including emergency, inpatient and comprehensive outpatient clinics, trying its best to provide life and health protection for the public." Wanli Army said.
In terms of epidemic prevention and control, according to reports, Shanghai United Family medical staff also actively responded to the call, went to the community, actively integrated into the epidemic prevention and control work, became "big white", volunteers, and busy in the frontline of the fight against the epidemic. In mid-March, Yin Lei, director of the Department of Stomatology at Shanghai United Family New Town Hospital, and seven other medical staff went deep into a community in Pudong New Area to conduct nucleic acid testing. Nucleic acid sampling of 2,600 people in the community was successfully completed on the same day. In this wave of the epidemic, more than 40 medical teams responded to the call of the district health commissions to support nucleic acid sampling in the community.
It is reported that similar to Shanghai United Family Hospital, in the unprecedented epidemic encountered in Shanghai, more than 3,000 social medical institutions in the city took urgent action, and medical and nursing employees have formed a "party member vanguard team" and "volunteer commando team" to actively compete for the front line. At one nucleic acid sampling point after another in the city, the "big whites" of social medical treatment have become an important part of this line of defense, and many moving stories have emerged.
"In the anti-epidemic work, hundreds of social medical institutions in Shanghai have sent teams to the frontline of the fight against the epidemic, and the team members wear stars and wear the moon, go out early and return late, bear great physical and mental pressure, and silently guard the health of the citizens." The original intention and original intention of the social doctors who use the doctors, and the practical actions on the front line of the fight against the epidemic show their responsibility. Yan Dongfang, president of the Shanghai Association of Social Medical Institutions, said. (This article is published by "Seeing the Medical Community", reprinted with permission, and the author and source are indicated at the beginning of the article.) ）
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