First aid in the eyes of epidemic storm: waiting for the tide to recede

If the current epidemic situation in COVID-19 is the strongest storm in the past three years, the emergency departments of major medical institutions in Guangzhou have undoubtedly been pushed to the forefront of this super hurricane.

From 65438+February 7th, the implementation of comprehensive and accurate prevention and control of the "Ten Articles of New China", the cunning COVID-19 experienced a short period of groping and groping, and Guangzhou, which had the basis of Haizhu epidemic, finally spread widely in a week or so. People began to have a high fever, whole body aches, chills, severe cough and bloodshot sputum. Although we broke up with COVID-19 for three years, most people still felt scared and at a loss at the initial stage of infection, so they had to turn to hospitals and doctors.

It is also the coldest time of the year in Yangcheng, so the emergency system of major medical institutions in the city, represented by the emergency department of the First Affiliated Hospital of Jinan University, has ushered in the busiest, most understaffed and most difficult time for first aid.

From mid-February of 120, the public generally reported that 120 was difficult to make a phone call and there was a long queue for driving. As we all know, at that time, the whole emergency system in Guangzhou was in a busy time when it exceeded the standard for more than three times. "I have been engaged in first aid work for so many years. It's really the first time that I feel there are so many super old people in Guangzhou. This wave of epidemic has caused some elderly people to have symptoms of virus-like pneumonia. " Liu Hui, deputy director of the emergency department of the First Affiliated Hospital of Jinan University, told Southern Reporter. Zhu, the head nurse of the ward who has been engaged in first aid for 26 years, is even more outspoken. 65438+February, 2022, was the darkest moment when she worked in first aid for many years.

Now, the city's monitoring system has found that the infection tide in COVID-19 has broken the wall, pushed all obstacles aggressively, and began to quietly subside. Tianhe City and Jiazheng Business Circle, two kilometers away from the First Affiliated Hospital of Jinan University, are crowded again. Emergency personnel still dare not relax a little, ready to continue fighting.

"The end of the epidemic predicted by experts will last until after the Spring Festival, and the overseas dominant strains after full liberalization are still eyeing, and it is far from time to relax."

65438+February 15

A large number of elderly patients suddenly poured into the emergency department.

Young people infected with Omicron generally have mild symptoms, but this strain is very unfriendly to the elderly, especially the very old.

What impressed Liu Hui was that on the day of 65438+February 15, there was still chilly winter rain in the sky. The emergency department suddenly squeezed into dozens of white-haired old people. "Generally, they are over 90 years old, sitting in a wheelchair or lying in bed with their families, sighing and having difficulty breathing. Every breath is difficult and unusual. "

Omicron's attacks on young people mainly focus on the upper respiratory tract, which is not enough to affect breathing, oxygen and human life. However, the elderly population is different. When checking the oxygen saturation, it is basically above 70 and above 80, which is far from the safety threshold of above 93.

Then do chest plain film scanning through emergency CT, either typical virus-like pneumonia or simple white lung. Therapeutic drugs must be used in time, but the most critical oxygen therapy needs to be used in time.

There are 17 observation beds in the emergency department of the First Affiliated Hospital of Jinan University, which can guarantee the first aid of more than 30 people in the hospital. But this is set according to the routine process, and the emergency impact brought by the infection tide in COVID-19 is obviously extraordinary. Every old man needs oxygen, which takes up a set of oxygen therapy equipment. Of the more than 300 emergency cases every day, nearly 100 need oxygen.

The observation area with a design capacity of 17 beds is packed with medical flat beds and wheelchairs, and it is difficult to find a place to put garbage. At the peak, the observation area was crowded with 60 old people. The nice guy who can still move consciously pushes his position in. They know that at this time, whoever can make room for a person's treatment will have more hope for a successful life rescue.

17 beds use fixed oxygen pipes for the elderly, so moving oxygen cylinders and pillow oxygen bags become life-saving "life-sustaining equipment". "These old people and their families also moved and worried our medical staff. They are quietly absorbing oxygen and losing water. When an old man who is seriously ill in an observation bed or a flat bed dies unfortunately, the old man waiting in the bed will silently wait for the medical staff to deal with it quickly, and then lie on that bed without taboo and calmly receive the treatment provided by doctors and nurses. They are all old people who have been used to wind and rain for nearly a hundred years and have a more detached understanding of life and death. "

At that time, the emergency ward was quiet and solemn. Obviously, hundreds of people are crowded into a narrow space. Obviously, most people still suffer from various discomforts caused by lack of oxygen, but sighs like alas are rarely heard in the ward.

Saving lives in a crowded space

Gather the strength of the whole hospital and start to dredge the emergency department.

The infection tide in Yangcheng is rising, and the incoming electricity of 120 has already exceeded the 100 mark. The emergency department of the First Affiliated Hospital of Jinan University can only do Dojo in snail shells. Only 17 observation beds are obviously unbearable, and an observation area of 50 to 60 people can be reserved by squeezing a flat bed. Every day, 200 to 300 people flock to the emergency department. At most, nearly 340 people squeeze into the emergency department, and as many as 50 to 60 people have to be rescued in the emergency department every day.

The first urgent problem is manpower, and the emergency department's own surgical and pediatric medical teams were first mobilized. Liu Qiyao, a pregnant nurse, also rushed to the front line of rescue with an oxygen bag. Jiang Yabin, the old director, also rushed to the forefront to participate in the rescue consultation and even personally participated in the rescue operation.

More than 0/00 doctors and nurses in the whole department/KLOC, except one obstetrician, all went to the front line. After infection, it becomes yang, and it persists without symptoms. Symptoms are obvious, get through the acute stage of fever and continue to work. "This infectious attrition is the most helpless for medical staff. One or two at first, then four or six. The superior spread of Omicron strains is even more arrogant and unscrupulous in the crowded emergency department. "

There are four female doctors in the emergency department of this hospital: Liu Hui, Rong Zhang, Zhou Youfen and Zhou Yijuan, all of whom have passed the examination. Wu Shangxi, a young nurse, has been in the emergency department without taking a day off. His colleagues think that he can enter the "final" without Yang. The fact is, this young man is already Yang, and he has many symptoms such as fever and dizziness. On February 28th, 65438, when the department was the busiest, Chen Yide, an old nurse, found Zhu, the head nurse, and reported that she had started to have a fever and was antigen-positive. "I thought he was going to ask for leave, but he said he had just taken antipyretic and could walk. I am a boy, I can get through it and I can stick to this night shift. "

The treatment barrier built by emergency doctors and nurses with their bodies is still being pounded by waves of emergency tide. Liu Hui told Southern Reporter, "The most impressive thing is that on February 26th, 65438, 2 1 emergency rescues were completed in the morning, and the whole hospital transferred and diverted 18 people. At noon, more than 20 elderly people suddenly poured in and needed oxygen or even ventilator support. "

When the venue, bed and ventilator were tense, an old man also suffered from sudden cardiac death. There's really no room. Patients in the observation area spontaneously approached each other, freeing up less than two square meters of space. Dr. Zhou Youfen knelt on the ground to perform cardiac compression and various drug infusion treatments for the elderly.

The unavoidable topic of death

The old director undertook the work of death report.

COVID-19 virus mainly infects the respiratory system. When the oxygen saturation drops sharply after the respiratory system is involved, the ability of oxygen-carrying blood to perfuse various organs of the whole body is greatly reduced. Then where the blood supply and oxygen supply to organs are insufficient, which organs will start to fail, which is life-threatening.

When tens of thousands of patients with emergency needs rush into the emergency department through 120 every day, the denominator is close to infinity, which turns even lower death probability into cold death data and remains.

The same is true of the emergency department of the First Affiliated Hospital of Jinan University. Doctors and nurses tried their best to save lives but failed. Too late to wipe the sweat off your forehead, too late to feel helpless and embarrassed. I took off my medical gloves and pressed them heavily on the decontamination bottle to show my resentment. Change a pair of gloves and rush to the next serious illness.

It is said that there is no hard winter, but the lives of these elderly people who died of severe respiratory distress and systemic multiple organ failure came to an end this winter.

Jiang Yabin, the old director of the emergency department, and Liu Hui, the deputy director, will personally participate in the on-site command and rescue every time there is a serious patient in the rescue room. When modern medical science and technology failed, Jiang Yabin, who has been practicing medicine for many years and is used to life and death, took over the complicated work of the funeral system without any mistakes, and let the frontline doctors and nurses try their best to treat patients. "Every time you declare through the system, it takes more than an hour for a skilled master." The old director is very clear about the information, illness and cause of death of each deceased, and he is present at every rescue process. He can only silently input the last text information of each dead person with a livid face, and complete the filing and sending.

There is not a spring that will not come.

The tide has receded and the dawn is ahead.

All patients are crowded in the emergency department with limited personnel, rescue equipment, resources and space, which is definitely not conducive to saving lives. We must mobilize the whole hospital to divert and divert.

Xu Anding, president of the hospital, and Guan Sicheng, secretary of the Party Committee, started the overall planning of the hospital at the first time when the emergency tide came. Zheng, vice president, went to the emergency room every day and set up a group to treat critically ill patients as a whole. All the elite clinical departments, both positive and negative, began to support the emergency department, ensuring that all the patients in the emergency department should receive better treatment. The expansion of the emergency department has also been rapidly promoted. The site has been transformed, the existing site and mobile board room have been expanded, consultation rooms and beds have been added, and ventilators, sputum aspirators, infusion pumps, monitors and other equipment are complete.

The help effect of other clinical departments on the emergency tide is also immediate. With the support of Director Yin Haiyan, the ICU of the hospital center opened the passage from emergency to ICU. As long as there are empty beds in ICU, the most critical patients in the emergency observation area will be transferred to the more advanced life support unit ICU for further treatment.

Coupled with the interdisciplinary treatment of other brothers' specialties, the pressure in the emergency department gradually eased.

The average age of the elderly in the observation area is declining, and now most of them are people in their sixties and seventies. More than 300 emergencies are also declining every day, and the dispatching instructions from the 120 emergency command system begin to flow smoothly. Director Jiang Yabin rarely sits in front of the death declaration system to report cold data.

This violent emergency wave is slowly retreating.

On June 65438+1 October1day, 2023, Guangzhou Municipal Health and Health Commission announced that the epidemic situation of COVID-19 infection in Yangcheng had reached its peak. The nearby Tianhe Ding Gang Business Circle and Tianhe City Business Circle are busy again, and the crowds are surging.

Spring in 2023 is near!

Written by: Southern Reporter Wang Daobin Correspondent Zhang

Video and Photography: Southern Reporter Zhao Ming