She smelled a strong stench in the air. Looking under the patient, the sheets turned into hot chocolate. "Incontinence!" The tip of Yunmei's upright nose wrinkled. She quickly glanced at the test results that had just come out, and her face looked even uglier than before. "Doctor Yun, the patient's condition has begun to deteriorate again!" At this time, the nurse shouted again. Yunmei quickly looked at the blood pressure. The patient's blood pressure began to fluctuate violently again, and it was not stable at all. "Tell the family members that they may need to be transferred to the ICU, and I'll call the director." Yunmei divided the work calmly. The patient's condition is too critical, and the conventional rescue procedures in the emergency department may not work, so we can only place our hope in the ICU. …
Dong dong dong—— Yun Mei knocked on the door of the director's office for a long time but got no response. Her heart skipped a beat: The director was most likely undergoing surgery. Just when she felt helpless, a figure suddenly appeared in front of her. A trace of joy flashed in Yunmei's eyes. She ran to the office and shouted inside: "Doctor Xu, there is a patient in the emergency room. Can you go and see him?" Xu Qiu, who was reading the literature, raised his head and said, "Well, lead the way." … On the way, Xu Qiu listened to Yunmei's report on the patient's basic condition, examination report, etc. The patient’s name is Zhang Qiulan. Female, forty-seven years old; Flexible employment staff. I suffered from liver cancer seven or eight years ago and had surgery. All the follow-up examinations over the years have been normal. This time I was admitted to the hospital. After receiving fluid infusion at the clinic, I suddenly felt cold and dizzy. Then I started to have a high fever and my skin became red... After returning home, my family called 120. After that, he was admitted to hospital urgently and had his blood drawn. "Transaminase: 1800U/L (normal value 0~40U/L) Bilirubin: (normal value )” These two items are indicators of liver function, and excessive levels mean liver damage. Kidney index serum creatinine: 3200 μmol/L (normal value 30-102 μmol/L) Heart function indicator brain natriuretic peptide: 12000pg/mL (normal value 0-100pg/mL)
Liver, kidney, heart, every indicator is so high that it makes one's scalp numb. What's more terrible is, The patient's coagulation indicators completely collapsed! PT, APTT, TT, etc. are all extremely prolonged, which means that the patient's hemostatic speed is extremely slow and the patient's hemostatic function is almost lost. Fibrinogen is severely low... With so many abnormal items, every system in Zhang Qiulan's body was on the verge of collapse, and a diagnosis was about to come out—— Multiple organ failure! Coupled with the loss of control of coagulation indicators: Multiple organ failure combined with DIC (disseminated intravascular coagulation)! This is a life-threatening emergency at any time. "Have you contacted the ICU?" Xu Qiu asked. Yunmei nodded quickly: "We have contacted her, and we should have a good deal with the family." Xu Qiu quickened his pace. As soon as we arrived at the emergency room, the family members stood up from their chairs and said with fear: "Doctor, we agree to transfer to the ICU. We must save my wife no matter how much money is spent..." Xu Qiu entered the emergency room and quickly glanced at the situation. My blood pressure is lower than before, now only 72/38mmHg. The patient's body temperature also rose to degrees Celsius, indicating high fever. In the ward filled with stench, Zhang Qiulan's whole body twitched and applied evenly. Her face was extremely pale, and her life was like a candle swaying in the wind, as if she was about to reach the end of her exhausted life... "Transfer to ICU." Xu Qiu said immediately. This kind of patient cannot be saved by any emergency department, and can only rely on the secret skill of ICU: banknote ability. … Within an hour, Zhang Qiulan was transferred to ICU for monitoring. After she was transferred to the ICU, another set of blood was drawn from her, and blood cultures were also done. The results show that: Blood lactate was 17mmol/L. This frightened the doctor.
A blood lactate level greater than 4 indicates a serious condition, and a blood lactate level greater than 8 indicates a poor prognosis. And Zhang Qiulan's blood lactate reached a terrifying 17! "Isn't it anaphylactic shock?" Yunmei said calmly while looking at the test results. Xu Qiu shook his head. Anaphylactic shock is a reaction that occurs quickly after exposure. The relationship between the body and allergies is as intense as that between an eighteen-year-old man and a thirty-year-old woman. Zhang Qiulan waited until she got home before she became ill, at least for half an hour. The timing of the attack is wrong. also, Anaphylactic shock is almost impossible to cause multi-organ failure. Xu Qiu looked at the ICU inspection report again. The white blood cell count is units, which is between 4 and 10 for normal people, which is significantly reduced. All this means, Zhang Qiulan either has a blood system disease. Either, During the infusion, she developed a serious infection! "Septic shock..." Xu Qiu's voice fell softly. Yun Mei, ICU Director Jiang and others were suddenly startled. right! High fever, multiple organ failure, and reduced white blood cell count are all consistent with septic shock. Just...how could such a serious infection occur? "Even if the clinic's hygiene conditions are not up to standard and there is no disinfection before the injection, the bacteria from a small amount of skin would not cause such a serious infection!" After thinking for a while, Director Jiang couldn't figure out the source of the infection. Xu Qiu was also a little puzzled. The family didn't know what fluid Zhang Qiulan had received. The clinic's hygiene conditions, storage capacity, etc., were also unknown. If the liquid needs to be stored at low temperatures, and there is no constant temperature storage equipment there, many liquids at room temperature may become a culture dish for bacteria. Infusing this kind of liquid is almost like injecting the bacteria's nest directly into the blood. "First notify the family to call the police and take samples as soon as possible. In addition, notify the family to apply for one or two bags of blood." Xu Qiu arranged it.
Given Zhang Qiulan's condition, blood purification must be done. Blood transfusion will be required later. Prepare in advance, it can be used during rescue. "Okay, I'll go and explain to the family." Yunmei agreed, and hurried to talk to the family. ... Blood purification is easy to solve, and you can get it if you have money. But blood use—— The hospital and the blood station are managed separately. If the emergency department wants to apply for blood use, in addition to the attending doctor filling out the application form, the blood station must also review the patient's qualifications before approving the use of blood. Like Linhai First Hospital, The blood station is staffed by the Municipal Blood Center, and it is difficult for the hospital to interfere. Whether to approve the use of blood is also decided by the blood station. After explaining to Zhang Qiulan's husband, the other party nodded and went to the blood station to submit the application in a daze. As a result, the staff of the blood station refused. Mr. Zhang's numb eyes moved. His expression was a little dull, and he said: "I really donated blood-I donate blood every year! You can check it, check my ID card, I brought my ID card!" The blood battle clerk shook his head: "You need to bring the blood donation certificate. I only recognize the blood donation certificate." Mr. Zhang was silent for a long time, he nodded, and went home to get the blood donation certificate obediently. More than an hour later, he came back with 20 or 30 free blood donation certificates. He said proudly: "Look, I didn't lie to you. I have been donating blood for almost 20 years, almost twice a year - please approve two bags of blood for my wife!" The clerk flipped through a few of them and shook his head again: "It's still not okay. You donated your blood in other places, but giving you blood consumes the inventory of this city." Mr. Zhang was stunned for a moment. He picked out a few of the latest ones and said: "These four are all from Linhai City!" The clerk shook his head again: "It's still not okay. Your wife needs blood, so you need your wife's blood donation certificate." "It's okay, she has it too. Look, here! My wife's blood donation certificate!" Mr. Zhang took out three or four blood donation certificates from his pocket and slapped them on the table. The clerk flipped through a few pages and threw them aside, knocking on the table and saying: "This one is also not qualified. The blood donation record must be from the last six months!" Mr. Zhang was stunned. He gritted his teeth and his eyes were about to burst into anger. Let his wife donate blood now? Isn't this bullying an honest man? He suppressed his anger and said, "I am a retired soldier, and my son is a soldier in the frontier. Both my father and I have donated blood many times in the frontier. Now we need two bags of blood to save the woman at home. Why not! Isn't it said that free blood donations are given priority?!" The clerk laughed contemptuously and finally told the truth: "Many surgeries require blood and we don't approve it. Now there is a blood shortage. There is nothing we can do! If you want blood, then come and exchange it. Your wife is type A blood. If you need two bags, you can ask someone to donate two bags of type A blood. Otherwise, there is no room for negotiation!"
At this moment, suddenly, the bell rang!