There is less than a month to go before the "beginning of summer".
The one who reminded me of this was a new doctor author, her name is Su Chongshan.
She is an ICU doctor who has been practicing for nine years and has saved at least 1,000 lives, with an average of one person every two days last year.
Having experienced countless critical illnesses, she is accustomed to seeing life and death, but she is afraid of summer.
Two years ago, in the summer, she was confronted with a strange disease, one of the most dangerous diseases she had ever encountered. It's called heat stroke and is often mistaken for a somewhat severe "heat stroke." However, what is not exactly the same as heat stroke is that the temperature in the patient's body is so high that various organs begin to change.
In a short period of time, she took over 12 patients, 5 of whom died, and one of whom was unable to take care of himself.
At that time, no one thought about how many dangers were hidden in the summer sun.
I am an attending physician in the intensive care department of a tertiary hospital in Chengdu, and I have been working in the ICU for 9 years. I have seen all kinds of life-threatening serious diseases, faced many life and death parting scenes, and rescued thousands of patients.
The hardest thing for me to endure was the sound in the ICU department.
If the patient is stable, the ward is deadly silent, and they barely breathe in a coma. But this dead silence is always broken when I am unexpected, and whenever the patient is very sick and has an abnormal heartbeat, the device will make a "beep beep ......" sound.
This kind of alarm sound is like the sound of a large truck reversing, which is harsh and urgent, giving people a strong sense of urgency and oppression. I even developed a conditioned reflex to hear it and run over to deal with it and alert the nurse that the patient was abnormal.
Working in such a high-intensity, high-pressure environment, most of the medical staff in the ICU have sinus arrhythmias, including me.
So every time I come home from work, I just want to stay at home and relax, or go out for a bike ride or work out.
This feeling of horror has come up a lot in my career, especially in the summer of 2022.
I remember very well that it was the scorching heat of July, and a strange outbreak at that time brought this horrible alarm sound to my department repeatedly. I couldn't escape the alarm in my dreams, and the patients who were dying.
Since 1950, the temperature in Chengdu has exceeded 40°C only twice, once in August 2006 and the other in July 2022, when everyone was still wearing masks.
The summer of 2022, which lasted for almost a month with high temperatures of over 40°C, was destined to be an unusual summer.
The outdoor surface is hot, and when people stand outside for a few minutes, their skin feels burning, and everyone hides indoors to blow the air conditioner. Air conditioning consumes a huge amount of electricity, and Chengdu's electricity consumption has reached its peak, in order to cope with the problem of power shortage, our hospital has specially arranged electricians to deal with special situations.
At the beginning of July, I was on duty and also had a busy weekend, and I was the only one to deal with the patients in the whole department. Just as I was about to rest, another unconscious patient came in from the emergency department, a 58-year-old sanitation worker.
I was physically and mentally exhausted.
The sanitation worker's surname is Li. When Lao Li first arrived in the ward, I saw him like a poisoned patient, unconscious, but his hands and feet were twitching, and he kept vomiting. I leaned over and saw that his eyes were strange - they were staring upwards.
What's even more strange is that his body is hot, like a small stove, and the mercury thermometer measures 42 °C, which is almost the highest value.
This is a typical symptom of heat stroke. My heart almost lifted to my throat.
In the minds of ordinary people, heat stroke is a severe heat stroke, which doesn't seem to sound so terrible.
But in the hearts of medical staff, it is the first "killer" with the arrival of summer - the patient's body temperature will be above 40 °C, which is equivalent to a warm baby on the body, plus the high temperature of more than 30 degrees in summer, the human body also absorbs heat, and the whole body cannot be dissipated if there is heat, and it directly becomes a small oven.
You can also imagine that the maximum water temperature in a public bath is 45°C, and the water temperature in an ordinary bath is 40°C, and a normal person will not soak in it for more than 20 minutes.
Having heat stroke is equivalent to the whole person being stuffed in a hot bath for a long time, and the organs will be "boiled" by the high temperature, the cells of the internal organs will be damaged, and then the organs will also begin to fail.
To put it simply, Lao Li, the current sanitation worker, is slowly "cooking" the organs in his body.
And he is convulsing now because his central nervous system is already "cooked" under the high temperature, and he can't control his body.
In the case of heat damage to the body, the original cooling and metabolic function in his body will fail, and it is difficult to sweat again.
I arranged for the nurse to connect Lao Li to the respiratory monitor, and almost instantly, the instrument sounded a terrifying alarm again: beep! beep!
The monitor showed that Lao Li was seriously hypoxic - his blood oxygen saturation was very poor, only 63%, and it was normal to reach 90%.
His stomach and intestines have been "burned" out of the problem, and the stomach is constantly gushing out of the stomach regurgitation and vomiting food and saliva, which can block the airway at any time, which may lead to suffocation.
I ran to the door of the ICU and called Lao Li's family. There came an old woman dressed simply, she was not tall, with white hair, a little messy, and could not speak Mandarin.
I said to her anxiously: "Now Lao Li's whole body is like a fire, his body temperature is very high, and it is very difficult to breathe, and he needs to use a ventilator, otherwise his life will be in danger." Now it's important to save your life, I'll explain the situation to you first, and we'll sign the consent form later. ”
The old woman didn't react, her face was stunned. She simply replied, "Yes."
I rushed back to the ICU, intubated Lao Li and connected him to a ventilator to assist breathing, and used sedation, analgesia, anti-epileptic and other drugs.
At this time, Lao Li's breathing state gradually stabilized, and the muscle tension in his limbs and epilepsy gradually improved.
Lao Li has to dissipate heat first.
I instructed Nurse Wu and the nurses to wrap Lao Li Bing in an ice blanket and wear an ice cap to cool him down. But this alone is not enough, his body is so hot, and the consumption is also very large, and he needs infusions to replenish the nutrients and water lost by the body. Lao Li's nasal cavity was also inserted into a tube to feed nutrition.
When the body temperature increases, the body loses water and the blood is concentrated, and secondly, when the cells are damaged by the heat, it also causes the blood to concentrate. We gave Lao Li anticoagulant drugs to prevent his blood from clotting and unable to circulate. At the same time, we started dialysis treatment.
Lao Li's body was covered with all kinds of tubes, surrounded by ventilators, dialysis machines, and ECG monitors, and the "beep-beep" sound gathered together and began to change the frequency, and my nerves became more tense.
The core of heat stroke treatment is to lower the patient's body temperature and return to the normal temperature of the human body, reduce the patient's pain with early anesthesia, help the patient breathe normally, and at the same time supplement nutrition, so that the body has energy metabolism.
These treatments can only keep Lao Li alive for the time being.
Lao Li could not undergo any surgery. Patients with heat stroke often have abnormal blood clotting function, and it is difficult to stop the bleeding during surgery, and they will die directly.
The senior director of our department suddenly called: "The sanitation workers collected this afternoon, you have to do your best to rescue them, the government has already told the leaders of our hospital, and the government will find a way to pay for it." ”
After several hours of rescue and treatment, Lao Li's blood oxygen reached 96%, his heart rate and blood pressure were normal, but his body temperature did not drop at all, and various organs of his body were still slowly failing in the high temperature.
We can't let his organs be "cooked" anymore, we have to cool him down, how much can be saved. Otherwise, even if he is rescued, he may be paralyzed.
I prepared the consent form and went to the conversation room to explain the situation to the family.
The old woman was still alone in the conversation. Her eyes were red, tears welled up in the corners of her eyes, she was anxious and overwhelmed. She realized that her wife was seriously ill.
I asked, "Mother-in-law, what about your children?"
The old woman wiped away the tears hanging from the corners of her eyes, "The two sons have just gotten off work and are rushing to the hospital. ”
The two sons do not work in the city, but work in the surrounding suburbs, which are more than an hour's drive from the city. The two sons do not have a diploma, mainly do manual work, and have a wife and children at home, so they live a very poor life.
The old woman stared at me: "Doctor, what is our old Li bag? Our family doesn't have any money, so we buy rural social insurance." If we can't save it, we won't save it, and we won't spend money in vain. ”
Before I could tell my mother-in-law about Lao Li's situation, she had the idea of giving up.
I comforted her: "Mother-in-law, don't worry, don't worry about the cost, because I am sick at work, the work unit will pay for Lao Li's treatment, the government just called our hospital leaders, let you not worry about the cost, we will do our best to treat." ”
Seeing that my mother-in-law breathed a sigh of relief, I told my mother-in-law about Lao Li's situation, including the treatment risks and prognosis of heatstroke. I was worried about whether she understood and explained repeatedly. It took me half an hour before she understood.
Her expression changed when she heard this, and there was fear in her eyes. Then, she went limp, trembled, and began to cry. I quickly helped her to sit in a chair.
I was also a little flustered, so I could only say, "We will do our best to save it, don't worry!" I repeated it several times. Lao Li's condition is very serious, I dare not promise anything, and I can't bear to watch the old woman uncomfortable.
When my mother-in-law was in a better mood, I left the conversation room.
Lao Li is usually not in good health, and he is getting older, and multiple organs are failing quickly, which increases the difficulty of treatment.
The next day, when I was doing my rounds at 8 a.m., I found that Lao Li's body would twitch from time to time, he had seizures, and the damage to his nervous system was somewhat serious. His kidneys were also damaged by the high temperature, and he was no longer able to urinate normally, resulting in many toxins in his body being unable to be excreted, which in turn affected more internal organs.
I now see that Lao Li's whole body is covered with bruises.
Suddenly, the alarm sounded, or because of the inability to cool down, Lao Li's blood clotting function was abnormal again, his skin and digestive tract were bleeding, and even a small amount of blood appeared in the airway of breathing. Lao Li was still in a state of shock, and it was difficult to see his pain. But the "beep-beep" sound from the dialysis machine is changing in frequency and tone.
I in front of the hospital bed, he in the hospital bed, were all listening to the suffocating sound in a very suffocating space.
Lao Li has already stepped into the ghost gate with one foot.
Lao Li's blood system is faulty and his kidney is failing, so he can only be assisted by external forces to help Lao Li's blood circulate in his body. After discussing Lao Li's situation with several doctors in the department, I decided to use hemoperfusion technology, which will guide Lao Li's blood out and "wash" it, and then transport it back into the body after it is clean.
A week has passed, and Lao Li's condition shows no signs of improving. It's bad that the effect of hemoperfusion is not noticeable.
Lao Li's daily cost of dialysis and blood purification is six or seven thousand yuan, and the cost of blood transfusion is two or three thousand yuan a day, and the cost of these two major treatments alone is close to 10,000 yuan. Additional drug costs, monitoring fees, ventilators and other expenses are included, and it costs more than 10,000 yuan per day.
As far as I know, sanitation workers in this area are paid less than 5,000 a month.
The medical expenses continue to pile up, and there are more and more outstanding orders. The government's renewal is also timely, which Lao Li's family can't afford.
Director Gao and Mr. Yang from the Medical Department also cooperated with the family and communicated with the relevant departments many times to introduce the treatment situation, hoping that the government would support the medical expenses.
Lao Li's two sons live outside the city, busy with their livelihoods and families, and rarely come to the hospital, nor can they afford treatment. Worried that there would be no one to help pay for the medical bills, they went to the relevant authorities to collect the payment several times.
The relevant departments arrange staff to visit Lao Li from time to time. They said they would find a way to solve Lao Li's medical expenses.
Lao Li's condition is too serious, and he still has symptoms of high fever and multi-organ failure. He was unconscious, he couldn't feel the care of his leaders, he was under general anesthesia, and he couldn't feel pain. There was only a "beep" sound, and the value on the instrument changed, showing that Lao Li still had vital signs.
My team and I hope to get Lao Li back, but at the moment we are a little helpless.
Every time the mother-in-law came to visit, she cried and called Lao Li's name, and the roar permeated the entire ward, even overshadowing the "beep" sound of the instrument, alarming the family members who visited him in the hospital bed, and turned their heads to look at her.
My mother-in-law said to me, "Why can't I shout Lao Li, he can't wake up yet?" Our Lao Li has worked hard all his life, and he has suffered a lot of crimes, and now his body is full of tubes, and he can't cry out in pain. He lived a miserable life. ”
I didn't know how to answer, so I handed her a tissue and patted her on the back as a sign of comfort.
The mother-in-law took it and wiped her tears, "Can he eat by himself when he is alive?" The two sons couldn't afford it. They don't have an easy life either. I'm also getting older, and my legs and feet are not very convenient. We want to take Lao Li home and serve him for two days. ”
I understood what my mother-in-law said.
The two sons rarely came to see their father. They are busy earning money to live, and every day they stop is less than a day's wages. In the current situation, the more they wait, the more tormented they become, and even the more passive they become.
Lao Li is injured at work, and if he talks to the relevant departments in advance, he may get more compensation.
Soon, the old Li family couldn't bear it anymore. The two sons began to discuss with the relevant authorities. The other party promised to bear Lao Li's discharge fee and give Lao Li's family some compensation.
After the negotiations, my two sons came to see me. They stood in the middle of the conversation, covered in dust, with solemn expressions and a little reserved. The old woman was there too. It was the first time I saw my two sons and mother-in-law there.
The eldest son spoke first, "We have already found an ambulance to take him home, please ask Dr. Su to help with the discharge procedures." Thank you, sorry for this time. ”
In the past 16 days of rescue, I have also tried my best. When I heard the news, I still felt a little uncomfortable, and I had to respect the family's decision at this time.
After they signed, I went back to the ward. Nurse Wu was still beside Lao Li, "Have the family members of the 4 beds decided to go home?" I nodded.
Sometimes that urgent "beep" sound disappears in this way, removing all instruments and sending the patient home.
Lao Li's discharge from the hospital pierced my heart like a thorn and deeply hurt me.
This emotion has been weighing on me. Coupled with the continued high temperature in Chengdu, I was afraid of encountering heat stroke patients again.
At that time, my colleagues in the branch hospital sent me a WeChat message, and they also began to receive patients with heat stroke, all of whom were in serious condition. At the beginning of the disease, the patient is already suffering from multiple organ dysfunction, which is difficult to treat. My worst fear is still coming.
The day after Lao Li left, the branch hospital sent another comatose patient with heat stroke, his name is Xiao Yang, he is a courier, 30 years old.
Xiao Yang fainted on the street and was found by passers-by and taken to the hospital. Before he passed out, he had been working in the heat for more than 10 hours.
When Xiao Yang was sent, like Lao Li, he was in a deep coma and his organs were damaged.
Even more deadly, he was already suffering from severe acidosis.
When a person is in a state of shock, the blood supply to the heart will decrease, affecting the oxygen supply, resulting in the body's metabolism being blocked. After we exercise, the soreness on our body is caused by lactic acid, and Xiao Yang's current lactic acid cannot be discharged normally, which will be life-threatening.
At this time, Xiao Yang can only go to bedside dialysis to help his damaged kidneys run and discharge toxins such as lactic acid.
I watched Xiao Yang's body temperature continue to be above 40°C, and I quickly ran to the conversation room, ready to communicate with Xiao Yang's family about how dangerous the situation was.
I pushed the door in, saw an elderly couple in their sixties and seventies, and hurriedly asked, "Doctor, how is my son?" Standing next to them was a woman in formal clothes, who looked like she had rushed from the workplace immediately.
"What is your relationship with the patient?" I asked, closing the door.
The woman rushed to say. "I'm his sister, and I'm my parents. ”
I thought that Xiao Yang was 30 years old and should be married, and it would be better if his spouse authorized to sign, "Is he married?"
My sister held back for a few seconds, "He has been divorced for more than three years, and if he needs to sign, I'll sign it." ”
I didn't ask anything more, the most important thing was to save the patient. Let me first briefly explain the situation: heat stroke is a very serious heat stroke, causing damage to multiple organs in the body, which may endanger the patient's life at any time, even if he saves his life, he may not be able to take care of himself after being rescued, and the cost of this disease is also very high.
My sister didn't have a moment of silence or hesitation, "Please ask the doctor to do his best to save me, I only have this one brother." It has not been easy for him over the years, his wife has run away, he has been in the doldrums for three years, and he just started to work as a courier, who would have thought that he would encounter this the next day. Please, doctor!"
The old man and the old lady were always silent, with tears in their eyes, looking at me.
I briefly calmed them down and rushed back to the emergency department.
Xiao Yang wrapped himself in an ice blanket and put on an ice cap, his body temperature gradually dropped, but the previous high temperature had caused his brain to begin to swell, and then the pressure in the skull increased. The extent to which Xiao Yang's eyes bulge out at the moment is already very terrifying.
The sound of the alarm came from time to time. To be honest, I was not sure that I would save Xiao Yang's life.
At four o'clock in the afternoon, the family came to visit. When my sister came to the bedside, she saw Xiao Yang's eyes protruding, nasal bleeding, and her face was dark, and when she touched Xiao Yang, her whole body was cold, and tears fell on the bed, "Xiao Yang, Xiao Yang...... Wake up, open your eyes and look at my sister, Mom and Dad are also here outside the ICU. You have to be strong! You have to get better! There is still a long way to go!"
Xiao Yang was still in a coma, unresponsive to painful stimuli, and with the use of strong sedative and analgesic drugs, he couldn't hear at all.
The ICU is not allowed to accompany the bed, and the sister does not dare to let her parents see Xiao Yang's current situation, and the old couple is waiting anxiously in the corridor outside the ICU.
After my sister came out, I pulled my sister to a place with fewer people, "Now continuous dialysis and hemoperfusion have been used, we have all used what we can use, now we see if Xiao Yang can survive." The cost of treatment for this disease is very high, the cost is tens of thousands of dollars per day, Xiao Yang has no insurance, and you also have to consider the cost. ”
Xiao Yang's hospitalization fee is also a big problem. His parents are in the countryside, they are very old, their financial ability is limited, and they are unable to work. He can only rely on his sister. My sister is a salesman of medical beauty products, is married, has children, lives on the edge of the third ring road in Chengdu, and her income is not very high.
It's sad to think about it, if the family conditions of this family were better, Xiao Yang would not have worked hard in the heat and lay on the hospital bed.
My sister didn't hesitate because of financial reasons, she said: "I have already discussed with my husband, no matter what, even if I sell the house, I have to save it." I was very moved by those words.
But for this family, the cost is indeed a problem, and if Xiao Yang's unit can take responsibility, the burden on his sister may be greatly reduced.
My sister told me that her brother was sorting parcels at the courier station. This express station only has a double-door opening for ventilation, no windows, no air convection, no large cooling equipment inside, only a ceiling fan. The temperature in Chengdu was particularly high in those days, and the temperature in the station was also very high, and Xiao Yang worked in it for a long time, causing heat stroke.
My sister was a little embarrassed, "Xiao Yang just went to work and didn't sign a labor contract, maybe the courier company is unwilling to take this responsibility." "I still suggest she try it, after all, in Lao Li's case, the government bears the relevant costs.
Director Gao and Director Yang of the Medical Department were willing to help, and they got in touch with the courier company and told the courier company that Xiao Yang was in a serious condition and might die. In the end, there was no response from the courier company.
My sister also told me that the courier company did not pay for any medical expenses on the grounds that it had not signed a contract. She is ready to contact a lawyer to sue.
Director Gao later told me to try my best to give Xiao Yang cost-effective drugs to reduce the burden on my sister in terms of treatment costs. This is the last thing we can do for this family.
After two or three days, my sister paid tens of thousands of yuan in hospitalization fees.
Xiao Yang's treatment process is not much different from Lao Li's. We have blood transfusions and hemostatic drugs to improve coagulation abnormalities, and bedside dialysis and hemoperfusion therapy continue to remove toxins from Yang's body. At the same time, we control Xiao Yang's epilepsy symptoms and supplement nutrition.
It may be that Xiao Yang is young and has no underlying diseases. On the fifth day, a miracle happened! Xiao Yang's condition was under control!
After the anesthetic passed, we shouted that he could open his eyes, his eyes did not protrude, the muscle tone of his limbs decreased compared with before, he no longer had epilepsy, his lactate also decreased to normal, his coagulation function improved, his gastrointestinal bleeding also improved, and he no longer needed blood transfusions.
Seeing Xiao Yang's condition improve, my hanging heart let go. When I got home, I slept soundly and no longer dreamed of the "beep-beep" sound.
In the ICU medical WeChat group, everyone is also discussing this ghost weather, which is too hot to go out and easy to suffer from heat stroke. Some nurses complained that they couldn't take care of managing a heatstroke patient, they had to get busy as soon as the alarm sounded, they didn't have time to write the intensive care record, and they didn't get off work on time this month.
My situation is similar to that of a nurse, sometimes I have to take care of other patients, and I have piled up several medical records that have not been sorted out.
Spit and complain, everyone is also reviewing, improving the allocation of medical resources, plasma must be supplied in time, and ice cubes must be stockpiled sufficiently.
When it comes to Lao Li, everyone is very sorry and helpless. Everyone begged the hot weather to pass quickly, but there were no more heat stroke patients.
I was sitting in my office replying to a message in the group when a colleague came running over and said that Corey had received another suspected heatstroke patient.
I hurriedly trotted back to the department.
When the patient was brought to our department, the temperature under the armpit reached 42°C, and he had severe dysfunction of multiple organs.
He was still in a coma and screamed several times without responding. The patient's face was also very red, his whole body was bruised, his mouth and nose were bleeding, and he also had coagulation problems. This patient's acidosis was more severe than that of Xiaoyang.
The patient could no longer breathe on his own, and his colleagues in the emergency department were running a ventilator to keep him breathing.
Nurse Wu and I both gasped when we first took over this patient: "This is much more serious than Xiao Yang sent over, I don't know if I can save it." ”
I reported to Director Gao about the re-receipt of heatstroke patients. Director Gao sighed, "In the past year, we have not received a single case of heat stroke, and recently we received three cases of heat stroke in less than a month. This is too wicked!"
The patient is a 32-year-old delivery man from Guangdong.
In the afternoon, after delivering takeaways, he fell asleep in a friend's van without a window. By the time he was found, it was already past seven o'clock in the evening. In such a hot weather, the car is not ventilated, and the temperature is high, which is easy to induce fever and heat stroke.
The patient was brought in without family members. I called the number left by the emergency department, and it was his sister who answered the phone.
My sister has been contacted by colleagues in the emergency department. My sister was very nervous: "I know that Xiao Zeng has been sent to the hospital, we will book a ticket to Chengdu immediately, we agree to do everything, please doctor do his best to save him, please doctor, please ......"
The patient's name is Xiao Zeng, his hometown is Guangdong, and he came to Chengdu to work hard.
In the summer of 2022, Chengdu is still in the epidemic prevention period. It was extremely difficult for the family to rush over from Guangdong, and they needed to check their physical condition and quarantine in the hotel, and they estimated that it would be a few days later when they saw Xiao Zeng.
Xiao Zeng's condition is very serious, we don't have time to wait, after synchronizing the news to the family, we have to speed up the rescue. I hope Xiao Zeng can survive until his family comes to see him.
In the first two or three days, Xiao Zeng's multi-organ function did not improve, and he was transfused every day, and bedside CRRT treatment and hemoperfusion did not stop. The sound of various instruments is far better than Beethoven's "Symphony of Destiny".
Xiao Zeng's body temperature has always been above 40 °C, the ice blanket has been wrapped around him, the ice cap has not been taken off, and several buckets of ice cubes have been used. Such a high body temperature is very harmful to the organs of the whole body, and it is also seriously damaged to the brain and nerves. Maybe his life was saved and he won't wake up.
I was scared of something more dangerous. However, the last patient, Xiao Yang's life, was saved, which also gave me a little confidence. Xiao Yang's central nervous system was greatly damaged, his speech was not clear, and he had problems moving his limbs, like a chorea. I have approached the teachers in the rehabilitation department, hoping that they will intervene as soon as possible to help Xiao Yang recover.
And now Xiao Zeng has a high fever, and I am worried that his central nervous system will also be damaged.
"He hasn't woken up yet, and he has such a high fever ......" I interrupted my terrible association just in time.
After a few more days, Xiao Zeng's condition still did not improve.
As the doctor in charge, I need to call my family every day to keep up with Xiao Zeng's condition. Sometimes I'm busy, and the nurse in the department gets calls from his family. They came to Chengdu and were still quarantined in the hotel, so they were in a hurry, and they called every two or three hours.
We are also anxious, he is just 30 years old, and he is still very young.
Xiao Zeng had to cool down the temperature to alleviate his other symptoms. In addition to the conventional cooling methods, Nurse Wu put normal saline in the refrigerator and froze it to a low temperature. She and her nurse helped Xiao Yang lie on her side, raised her buttocks with a pillow, and then passed the frozen saline through the infusion set into the anus, and then injected the saline solution to achieve the purpose of cooling.
But his body temperature still hasn't come down, so we can only add medicine to cool down.
Heat stroke treatment guidelines do not recommend drugs to cool down, heat stroke patients have high body temperature, kidneys, liver has been "grilled" after the symptoms of failure, antipyretic and analgesic drugs have side effects, these side effects to the kidneys, liver is also very harmful.
Therefore, we generally do not choose drugs to cool down unless the patient's brain damage is severe.
I am worried that Xiao Zeng's brain will be "burned" and damaged, and he will not be conscious if he is saved, and he will not be able to walk, so he can only eat liquid food. And his organs are still being "grilled" and have been failing.
Only when the body temperature is lowered can there be hope for treatment. I explained the situation to Xiao Zeng's family, and they trusted us so much that our doctors made a bold decision to use hibernation mixture!
The main effect of hibernation mixture is to cool the patient's brain. However, it also has side effects, which may cause instability in blood pressure, breathing, etc., and may also lead to neurological disorders. Use with caution in patients with central febrile shock such as Xiao Zeng.
In addition, hibernation mixture cannot be used alone, and needs to be combined with heavy anesthesia, which is conducive to the patient's recovery.
We don't use much hibernation mixture, and we're worried that something unexpected will happen.
It was a risky medication, and the family had to take the risk. In addition, family members also have to deal with medical expenses and hospitalization expenses.
Xiao Zeng's daily treatment fee is also about 10,000 yuan, and I told my family: "The treatment cost is too high, he has no insurance, and now he owes too much medical expenses, and I hope the family will make up for it as soon as possible." ”
Xiao Zeng's sister said, "The whole family fully supports the rescue of Xiao Zeng. No matter how much it costs, we'll figure it out, and you don't need to worry about the cost. "I choked up when I heard the voice on the other end of the phone.
Due to the high incidence of heat stroke in a short period of time, many heat stroke patients have been admitted to various hospitals, which has also attracted the attention of relevant departments.
Director Yang of the Medical Department and Teacher Zhang of the External Relations Department came to visit Xiao Zeng in the department to learn about his family situation and economic situation. The two teachers contacted the food delivery company and the newspaper. The willingness of the takeaway company to take responsibility is not strong, and the newspaper reported on Xiao Zeng's situation and called on everyone to help Xiao Zeng.
The leaders of the hospital also emphasized that in terms of treatment costs, they tried their best to save some money for Xiao Zeng's family and reduce their burden.
The quarantine time has finally passed. Director Gao approved Xiao Zeng's father and sister to come to the ward to see Xiao Zeng.
Xiao Zeng's father and sister were wearing isolation gowns, masks, and red eyes. The little one in front of them was intubated and still under sedation, and there was no response.
Xiao Zeng was swollen all over his body and had extensive bruising. My father and sister wondered if the patient lying on the bed was Xiao Zeng, and I pointed to the patient's information next to the bed.
They looked incredulous, and then leaned back to look at them more closely. The father and daughter couldn't hold back, tears welled up in their eyes, and they desperately shouted Xiao Zeng's name.
My sister's tears wet the mask, and my father called Xiao Zeng's name several times, but he didn't react. The device emits a "beep" sound, like the sound of a stopwatch in the hand of the Grim Reaper, and the intermittent sobbing sound makes the ICU feel like a dead place.
I was worried that they would stay in the ward for a long time and that it would affect their confidence.
I took them to the conversation room and talked about Xiao Zeng's situation. I took Xiao Yang as an example, there is hope for rescue, but the prognosis may not be optimistic, and someone may need to take care of him. I was very impressed by my sister, who did not bask in grief but took a pen and wrote down her brother's situation in detail in a notebook.
After hearing about the prognosis, she said that she was willing to take care of Xiao Zeng.
A week later, Xiao Zeng's body temperature finally began to drop, and the condition of multiple organ failure gradually improved.
During this period, the condition of the previous patient, Xiao Yang, also got better and better, and after being discharged from the hospital, he went to a special rehabilitation hospital for treatment.
Now the only heatstroke patient in the entire hospital is Xiao Zeng, two weeks later, his body temperature is basically normal, and the hibernation mixture has stopped. The next step is to stop sedation.
To be honest, I really don't know the bottom of my heart, the early stage of the disease is so serious, the continuous high temperature has a lot of damage to the cranial nerves, I am afraid that he will not wake up or be hemiplegic.
Subsequently, I began to stop Xiao Zeng's sedative medication and try to gradually wake the patient up.
During the wake-up period, Nurse Wu would call Xiao Zeng's name before each shift change. For the first two days, Nurse Wu did not get any response from Xiao Zeng. She also asked me, "Why hasn't Xiao Zeng woken up yet?" and I was a little anxious, "Wait another day." ”
On the third day, before the shift change, Nurse Wu called Xiao Zeng in front of his hospital bed. Xiao Zeng suddenly opened his eyes and moved his head. Nurse Wu was very excited and ran to my office, "Doctor Su, Doctor Su, go to bed 4, Xiao Zeng has woken up and opened his eyes, you hurry up and take a look." ”
I quickly rushed to the bedside, I called Xiao Zeng's name, and he opened his eyes and looked at me. I asked him to hold his left hand, his right hand, and his feet. I put my hand on the instep of his foot and felt some strength as well.
I then checked the values in the instrument and looked at Xiao Zeng's body, the edema was not serious, and the bruises were less. I believe that after Xiao Zeng's sedative drugs are metabolized, he is likely to recover better and the muscle strength of his limbs will be better.
Now, I don't feel so disturbed when I listen to the "beep" of the dialysis machine.
Nurse Wu happily changed shifts. I walked out of the ward door and called my sister, "Xiao Zeng woke up and is in good condition." In the afternoon, you can open a WeChat video visit. My sister couldn't say anything, and I could only hear replies like "uh-huh" and "yes".
In the afternoon, the family called the family to their home and made a video call.
A big family, more than a dozen people appeared in the video, and greeted Xiao Zeng one after another. I vaguely heard someone say that when Xiao Zeng returned to Guangdong, he would introduce his daughter-in-law to him.
That day, I was very relaxed and wanted to go to the gym to sweat.
After a few more days, we successfully removed Xiao Zeng's endotracheal intubation, and the dialysis machine was removed, and the "beep-beep" sound was gone.
Nurse Wu took care of him very carefully, chatting with him every day and helping him turn over and move. Before Xiao Zeng was discharged from the hospital, the prognosis exceeded our expectations, which was a surprise to me.
Later, my sister sent me some videos of Xiao Zeng's recovery, he can basically walk normally, there is no unsteady gait, and he can basically take care of himself. It's just that he doesn't speak well, but I'm sure he'll get better.
And the situation of the previous patient, Xiao Yang, is not optimistic. In the video sent to me by his family, Xiao Yang is still unsteady walking, unclear speech, and unbalanced muscle strength in his limbs. Half a year later, Xiao Yang's symptoms did not improve, and he said goodbye to the life and work of a normal person. He needs to be cared for for by someone around him for a long time.
In the summer of 2022, the hot weather in Chengdu lasted a bit long, and later we received 9 more heatstroke patients. We treated a total of 12 patients with heat stroke, and only 7 patients were rescued.
I feel sorry for those 5 patients.
Heatstroke is so cruel that it's either death or injury. I and the hospital are very weak, the hospital has reduced the medical expenses to the greatest extent, and the director and I have also cooperated with the government or enterprises to understand the situation, and then contacted the media to attract everyone's attention, but it has not been able to fundamentally improve the survival of patients.
Xiao Yang's sister sent me a WeChat message, and they found a lawyer and sued the courier company unsuccessfully. Couriers like Xiao Yang, as well as other food delivery workers, sanitation workers, and construction workers, do not have high medical security, and most of the risks in case of heat stroke are borne by themselves. It is not an exaggeration to say that life is exchanged for money.
Later, our department held a seminar on "heat stroke".
Everyone found that even if we use the best treatment methods in our hospital, they only provide limited help to patients, and cannot solve the phenomenon of high mortality rate and lifelong paralysis of this disease.
Director Gao relieved us that this is not a problem that our doctors can solve. Only by attracting more attention from relevant departments and companies, not just advocating for front-line workers to take high-temperature vacations, but clearly requiring people to take shelter from the heat during the hottest time, and distributing related items such as summer medicines, can this problem be solved.
In the past two years, whenever I look out the window at the scorching sun, I always think of the high temperature and the patients of that year.
After writing this story, look through the calendar, and this summer will soon be here again.
Dr. Su still dreams of "beep-beep" sounds when he sleeps over the years.
She will also think of Xiao Yang, I wonder if Xiao Yang has received compensation?
At the beginning of April, the Sichuan Legal Inspection Department held a trial of a six-year-long administrative confirmation case for the determination of heat stroke work-related injuries. This case activates the rule of law that "occupational heat stroke (heatstroke) shall be recognized as a work-related injury". Maybe the "Xiao Yang" in the future will get a good ending.
Now that the beginning of summer is approaching, Dr. Su hopes that after reading the story, in addition to knowing about this disease, you can also grasp more knowledge to prevent and deal with it.
When it appears next to you, you may also be able to save the next "Xiao Yang"-
1. How do I find out if someone around me is suffering from heatstroke?
People who faint in hot weather need the most attention.
If the other person does not sweat, has a body temperature of more than 40°C, and is confused, it may be heat stroke, so call 120 immediately. In addition to the above-mentioned conditions, heatstroke may bring symptoms such as clammy cold, sweating, persistent headache, inappropriate behavior, flushing or paleness, nausea, vomiting, syncope, etc.
It is also worth noting that heatstroke can occur even in cool climates when performing high-intensity strenuous exercise.
2. What should I do after I find out?
Before the ambulance arrives, move the person to a cool and safe place and apply a cool towel or ice pack to the head, armpits, and thighs. If possible, blow with an electric fan and rain with cool water.
In the case of epileptic convulsions, do not put anything in the patient's mouth and do not feed water. If the person vomits, lie on the patient's side to ensure that the person's airway is clear and to avoid aspiration. At the same time, avoid overexposing yourself to high temperatures.
If we are on guard, we can make ICU doctors like Dr. Su no longer scared this summer.
(Some of the characters in the article are pseudonyms)
Edit: Big Rake Small Whirlwind
Illustration: Big Five Flowers
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