This doctor has a system

Chapter 370 435. Can someone with diarrhea be admitted to the intensive care unit?

Lloyd was stunned for a moment when he heard this, and then he was overjoyed. It was true. He had just been talking to Professor Hunter for a long time. Before, he would have been out of breath, but now he only felt slight chest tightness.

"Oh my god, I have to tell my mother this good news quickly!"

Everyone was very happy to know this situation. Soon, better news came from Professor Hunter, and the symptoms of the two babies were relieved to varying degrees.

The news spread quickly, and most people who paid attention to the clinical trial results were pleasantly surprised.

"More than 400 applications received?" Dr. Lu said in surprise.

"Not only that, there are still people trying to contact me." Zhao Kang said, "Some patients have already chosen to come here."

Since there is no specific drug, patients with spinal muscular atrophy can only wait for death. Now a drug suddenly gives them hope. This excitement is beyond description in words.

"There are too many people, and our medicines can't be supplied at all." Dr. Lu was a little troubled. "Let's communicate again and ask everyone to wait patiently."

"I'm afraid we can't wait," Zhao Kang said. "Nearly all of them are children, and many of them are quite seriously ill." I'm afraid that by the time the drug is launched, there will be no more people.

"There is nothing we can do about it. Judging from the current situation, we can recruit up to 50 patients." Dr. Lu said.

"What should we do?" Zhao Kang asked.

"It's bed 6. There's a patient with diarrhea." A weak-looking female doctor choked with sobs. "Doctor He has gone to the rest room. I'll call for you."

"Why are you still crying?" Li Youliang wondered, "Did you have a quarrel with the patient's family?"

"You make the decision on this matter." Dr. Lu threw the blame away easily, "It is your job to screen patients."

I'm not good at this job at all, okay? Zhao Kang thought to himself, but who is the person in charge?

At this time, Dr. He also came to the doctor's office, and it was he who ordered the consultation.

"Brother He, what happened to that doctor just now?" Li Youliang asked, "Why are you still crying? Were you wronged in the department?"

The doctor just now was called Xiao Qin. He just fell out of love a few days ago, and he felt really heartbroken. My boyfriend cheated on me, not just one leg, but several.

It really didn't matter if he said this, there was no need to cause too much trouble for himself.

"Mrs. Su Ya, you don't need to worry." Zhao Kang said with a smile, "I think your child's condition is relatively stable, and you can wait until the drug is launched."

The production of Noxinaxin Sodium is not easy. The synthesis conditions of several conversion products in the middle are very harsh, and the total amount produced by the largest laboratory is not large.

As a professional respiratory therapist, Dr. Qin was worried that he would burst his lungs from crying too much and develop respiratory alkalosis, so he divided his tears of love into several days.

Today's doctor-patient relationship is not good. Battles between doctors and patients' families are common. Young doctors often lose due to lack of experience.

"I have been crying for three days." Dr. He said, "It should be the final stage now, I guess it will be almost done tomorrow."

"It's possible." Gao Feng took a look and said, "It looks quite sad, and his eyes are swollen from crying."

"We are still in the clinical trial stage and there are many uncertainties. There is no need to put children at risk."

Su Ya is the 18th family member of a patient that Zhao Kang has persuaded to leave today. Smoke is coming out of his throat, but there are more people waiting to communicate with him.
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"Which patient needs consultation?" Gao Feng led Li Youliang into the office of the central ICU.

Closer to home, Gao Feng looked at the patient who needed consultation. The patient's initial symptom was diarrhea.

"It is true that she was wronged, but not in the department." Dr. He laughed, "Her boyfriend cheated on her and she broke up with her."

Professor Hunter also received a lot of phone calls, and there were quite a few people who approached him in a roundabout way, but he refused them all.

Can you be admitted to the intensive care unit if you have diarrhea?

It's really okay.

At least this patient has been here for 13 days.

His lower body was wrapped in three layers of diapers, and his body was filled with tubes: ventilator connection tubes, central venous catheters, invasive arterial pressure detection tubes, gastric tubes, and continuous renal replacement therapy tubes in his legs.

The patient was admitted to the local central hospital 5 days ago and was diagnosed with infectious diarrhea.

Since the source of infection has never been found, we can only fight the infection regularly. During the course of treatment, the patient's condition took a turn for the worse, with oliguria and difficulty breathing, and he developed into septic shock. I have used both invasive ventilator and CRRT but still no improvement.

After discussions with the family, the local hospital transferred the patient to the Provincial People's Hospital for further treatment.

The patient's initial examination results upon admission were not optimistic: body temperature 38.7°C, pulse 132 beats/min, lung auscultation with a small amount of crackles, ventilator oxygen concentration 80%, central venous catheter rapidly pumping norepinephrine (0.4ug/kg/min).

"He has had diarrhea at least 10 times a day for more than days, all of which are dark green."

Anyway, I poop during the day, poop at night, poop with my eyes open, and poop again with my eyes closed.

Up to now, the patient can no longer open his eyes and is currently in a light coma.

Gao Feng discovered that this was not the first time that the patient had been hospitalized in the provincial hospital.

The medical record system showed that the patient was 53 years old and underwent liver transplantation in our hospital 2 years ago due to hepatocellular carcinoma combined with cirrhosis. After surgery, tacrolimus (2 tablets bid), mycophenolate mofetil (3 tablets bid), sirolimus (1 tablet qd) and other drugs were used to control the rejection reaction. Over the past two years, the patient has been reviewed on time and his condition is stable.

Infection in patients after liver transplantation is not a trivial matter.

While fighting the infection, the local hospital also stopped all his immunosuppressive drugs.

This surprised Gao Feng: For patients like this who received liver transplantation due to liver cancer, in the "Clinical Practice Guidelines for Liver Transplantation for Liver Cancer in China", although there is no unified clinical plan for how to maintain the patient's immune balance, it does not advocate immunity. Total withdrawal of inhibitors.

However, it was an accident, and he did not ask for the reason. The doctor at the local hospital must have had other considerations.

"Should you guys go to the gastroenterology and liver transplant wards to have a look?" Gao Feng asked.

"I asked, but they haven't arrived yet." Dr. He said.

"Call to urge us and let's take a look together." Gao Feng suggested that patients who take immunosuppressants after organ transplantation are more complicated, so a multidisciplinary consultation is most appropriate.

Dr. He made several calls, and Director Ding from the Gastroenterology Department and Director Fan from the Liver Transplantation Ward arrived late.

"Busy." Director Ding must have just returned from the endoscopy room and was still wearing a surgical gown.

The two of them sat together and looked through the medical records, both looking a little unhappy.

"We have to call people from the infectious disease department." Director Fan from the liver transplant ward said, "This is their business and has nothing to do with us." "You did the surgery, so how can it be said that it has nothing to do with you." Director Ding laughed and said, "You're already here, please say a few words quickly."

Director Hou from the Department of Infectious Diseases also arrived at the office after a while, and he was not too happy either.

"Didn't I see this patient? Why do you call it a consultation?"

"The main reason is that I haven't gotten better after treatment these days." Dr. He explained, "I want to find the directors to adjust the plan."

"Lao Hou, the infection is your problem. Please bring it to your attention immediately." Director Fan was the first to speak up.

Director Hou really couldn't refute it. The patient did look like he had infectious diarrhea, but the key point was that anti-infective treatment didn't improve anything.

"If that doesn't work, just upgrade the antibiotics." He suggested.

Seeing that the consultation was going to be hasty like this, Gao Feng couldn't sit still.

"Let me just say a few words. Can we break down the current problem?"

"Break it down?" Director Ding from the Department of Gastroenterology was stunned for a moment, "Director Gao, what do you mean?"

"I took a look at the current medication regimen and found that there are many problems." Gao Feng said, "The first one is the issue of immunosuppressants. Should we continue to discontinue them or re-administer them?"

"Although the guidelines do not recommend total withdrawal of immune preparations, the patient's situation is quite special. Multiple days of diarrhea have caused blood concentration and the concentration of immunosuppressive drugs has increased significantly." Director Fan of the Department of Infectious Diseases said: "The patient was hospitalized with tacrolimus in his blood." The concentration has increased several times compared with before, and combined with the extremely low lymphocyte levels in the patient's blood routine, he is still in an immunosuppressed state."

Moreover, the patient's extensive infections and multiple organ dysfunction also make it difficult to maintain blood pressure. If immunosuppressive drugs are used again and the scope and degree of the patient's infection worsens, it may be the last straw.

Everyone nodded. Obviously, it is more appropriate to deactivate it now.

"Then continue the treatment of discontinuing immunosuppressants from other hospitals, closely observe the blood concentration of the drug, and then continue to use it after the immune function recovers." Gao Feng said decisively.

The anti-infective drugs currently used by the patient are imipenem-cilastatin 1g q8h + voriconazole 0.2g q12h. These two are the best anti-infective drugs.

Gao Feng noticed that the patient's stool routine on the day of admission did not report a possible etiology, but the blood culture results on the second day showed G+ cocci infection; yesterday's blood test and chest CT suggested the presence of fungal infection at the same time.

"Add amphotericin B and tigecycline." Director Fan said.

Hearing this, several people present frowned and immediately started using quadruple antibiotics. The patient was still a liver transplant patient. I wonder if he could withstand it?

"We have to resist even if we can't," said Director Fan. "We should still try to increase the antibacterial spectrum as much as possible."

His idea is simple. Since the pathogenic bacteria cannot be found at present, it should be widely covered.

In a popular sense, if you can't find the enemy's stronghold, then I will cover it all with firepower and I will always be able to kill you.

Although the high score felt inappropriate, he really couldn't think of a better way for a while.

The patient's condition obviously doesn't allow us more time to find out the cause of the disease before using medicine, and wide coverage seems to be impossible.

"Okay, let's put it this way." Director Ding from the Department of Gastroenterology stood up first, "The endoscope department urged me."

After walking out of the central ICU, Gao Feng was in a bad mood. This patient's situation is very pessimistic. He doesn't know if adjusting the plan will improve it. He still has doubts in his heart.

Is this possible for common infectious diarrhea?

Even if the patient is taking oral immunosuppressants after liver transplantation, he should improve quickly after taking imipenem, cilastatin and voriconazole.

These two medicines are not just cats and dogs.

It's equivalent to if you want to take some firecrackers to blow up the manhole, this will directly give you two C4 bombs. Logically speaking, the demand can be met.

"Come back and check again in two days. I don't think the patient's condition will improve." Gao Feng said to Li Youliang.

But what is somewhat disappointing is that the patient's condition is really gradually improving. On the 3rd day, the diarrhea had stopped; on the 5th day, the patient's peak body temperature gradually decreased and the oxygenation index rose to about 300.

With the reduction of analgesic and sedative drugs, it will be soon for the patient to be removed from the ventilator and transferred to a general ward.

During the course of treatment, the patient's lymphocyte count continued to rise, indicating that the immune function had also recovered. But anti-infection was still the top priority at this time, so Dr. He resumed the use of mycophenolate mofetil (500 mg bid) to suppress immune function according to the previously formulated plan.

So far, the condition seems to be under control: the diarrhea has stopped and various indicators have stabilized. The family members are very happy and have already made pennants.

Gao Feng was secretly worried: the cause of the infection has never been clear. If the problem is not solved at the source, the patient is at risk of relapse at any time.

But he couldn't say these words, it felt like he was cursing the patient for something to happen.

"Don't worry." Li Youliang consoled him, "Maybe the source of the infection has been killed."

For many infectious diseases, sometimes the patient has improved and been discharged from the hospital after anti-infective treatment before the source of infection is found.

"Maybe my worries are unfounded." Gao Feng said with a smile.

But at this time, Dr. He in the central ICU was already panicking. On the seventh day, the patient suddenly developed a large amount of watery diarrhea, which was difficult to stop even with multiple layers of diapers.

The blood pressure was unstable, the oxygenation index dropped to 200, and various inflammatory indicators increased. The patient also developed abnormal liver function indicators, suggesting the possibility of drug-induced liver injury.

The rapidly deteriorating condition caught people off guard. Dr. He immediately stopped enteral nutrition and added antidiarrheal (berberine) and hepatoprotective drugs (polyene phosphatidylcholine + magnesium isoglycyrrhizinate).

When Gao Feng arrived, several directors of the infectious disease department were discussing the use of antibiotics.

Some people suggest using ceftazidime avibactam. This product costs 5800 yuan a bottle, and you need to use 3 bottles a day.

"This is a big challenge to the financial strength of the patient's family."

However, the director's worries were obviously unfounded, and the family quickly spent 24 yuan to buy half a month's worth of ceftazidime avibactam.

Dr. He told them to buy a three-day supply first, but the family members who went out to buy medicine were afraid of trouble.

"I just thought about buying more spares," he said.

(End of this chapter)