An 82-year-old man in Hangzhou, whose lungs turned white after Yang, was once refused by his family, saying that he didn't want him to suffer.

According to the report of Urban Express, Chief Physician Cai, deputy director of the emergency department of EICU ward of Run Run Shaw Hospital, not only evaluates the patient's condition every day and tries his best to treat him, but also talks with his family to discuss the next treatment measures.

Facing the peak of intensive care, the emergency ward of Run Run Run Run Run Run Run Run Run Run Run Run Run Run Run Run Run Run Run Run Run Run Run Run Run Run Run Run Run Run Run Run Run Run Run Run Run Run Run Run Run Run Run Run Run Run Run Run Run Run Run Run Run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run run All the patients were seriously infected in COVID-19, and most of them were elderly people.

Do you want to further rescue, do you want to cut the trachea, such a dialogue is staged every day. Some family members cooperated and understood, and the conversation went smoothly; Some family members are hesitant and hesitant, and the conversation is deadlocked.

Whether to give up with the wishes of family members or to follow the doctor's sincerity, Cai chose the latter from the most comfortable and beneficial point of view.

In EICU, there is not enough time every day, but Cai still finds time. Once a conversation fails, it's only two or three times. "As a doctor, I always hope that patients can get better as soon as possible and be transferred out of the ICU. Therefore, when patients have the hope of improvement, it is even more necessary to let their families eliminate their doubts through our professional talks and work together to' struggle' for the rehabilitation of patients. "

The 82-year-old man got better after staying in EICU.

The first conversation suggested "tracheotomy"

Hearing this, the two sons repeatedly waved their hands and refused.

The 82-year-old uncle Hu is the patient who Cai talked to his family twice and "robbed" him. Three days ago, Grandpa Hu was transferred from EICU and continued to receive rehabilitation treatment in the respiratory ward.

Grandpa Hu has a history of diabetes, cerebral infarction and myocardial infarction, and his heart function is not good. On the evening of February 24th, 65438+,he was sent to Run Run Run Run Run Shaw Hospital of Zhejiang University for emergency treatment because of chest tightness and shortness of breath after being infected with COVID-19. "At that time, the body temperature of the elderly was nearly 39 C, and the oxygen saturation was only over 70%. He immediately accepted tracheal intubation and ventilator oxygen delivery. After treatment, the blood oxygen concentration can temporarily meet the minimum standard requirements. " When Cai mentioned it.

Further CT examination showed that Uncle Hu's lungs had turned white. Considering his age and many basic diseases, he was admitted to the emergency EICU with the consent of his family.

"Doctor, if you try to cure it, no matter where you cure it." The two sons are at the gate of EICU every day. The two brothers are worried that their father may not survive this, and even quietly prepared the funeral.

However, Grandpa Hu is very competitive. After seven or eight days of treatment, the blood indexes and the oxygen absorption capacity of the lungs have been obviously improved. The soaring blood sugar is well managed under the supervision of medical staff every 4 hours; Secondary infection, etc. , symptomatic treatment. Lung CT reexamination showed that lung inflammation was absorbed a lot more than before.

"The old man is getting better every day!" Cai informed the two brothers about the progress of treatment. However, it is obvious that the two sons are still pessimistic about their father's recovery.

According to Grandpa Hu's situation, Cai thinks that we can get ready to get off the ventilator and take off-line exercise for three days. However, during the exercise, Grandpa Hu's spirit is still a little weak and his ability to expectorate is not very good.

Uncle Hu's treatment faces several choices: First, continue offline exercise, or transfer to rehabilitation hospital to continue offline exercise; The second is to exercise for a few more days to see if you can successfully extubate. If you survive, you win. Third, tracheotomy, a relatively safe means, is easy to suck sputum and the progress of breathing exercise can be accelerated. In addition, after tracheotomy, sedatives and analgesics are no longer needed, and the patient's mouth is liberated, and he can eat and keep up with nutrition. In addition, the patient's hands and feet can move freely, and even get up and walk on the ground to avoid secondary infection and bedsore caused by long-term bed rest.

In the first conversation, Cai spent more than half an hour suggesting to the two brothers: tracheotomy. Unexpectedly, it was rejected by the two brothers. They said that mother didn't want her father to suffer.

We worked hard and the old man survived!

Two or three hours after the second conversation

Finally, "doctor, let's cut!" " "

The family refused tracheotomy, and Cai tried to get Grandpa Hu out of the ventilator and extubated. It was fine during the day, but at night, because I didn't have the strength to cough up phlegm, finally, Grandpa Hu re-intubated.

Although tracheal intubation can make patients oxygenated in a short time, the intubation time usually does not exceed 10- 15 days. Because the tube is pressed against the glottis and oppresses the throat, it is easy to erode after a long time. Although tracheotomy has certain risks, the risks are more beneficial to patients than the benefits. "The quality of life is getting better every day."

"Doctors always want patients to be the best. Now the old man's condition is improving. After gas cutting, he will relieve the pain, people will be awake, and hands, feet and mouth can move. Even if he is connected to a ventilator, his quality of life will be much better. " Cai called the two brothers and had a second conversation. This time, her tone was urgent. "I can understand my family's hesitation and embarrassment, but what I thought at the time was that I couldn't just give up."

Two or three hours later, Cai finally waited for the reply from the two brothers: "Doctor, let's cut it."

The ventilator was successfully taken out the day after tracheotomy.

Great white lung absorbed most of it.

Two days later, he was transferred to the respiratory ward.

On October 5th, 65438/KLOC-0, Cai successfully performed bedside tracheotomy for Grandpa Hu. The incision is less than 2 cm in diameter, and a small cover is placed, one end of which is connected with oxygen. That evening, Grandpa Hu began breathing exercises, and the ventilator was successfully unplugged the next day. Except that he can't talk, Grandpa Hu is in a good state of mind and can get up and sit in a hospital bed. 654381October 7, CT was reexamined again. Most of his lungs are absorbed and his oxygen saturation is within the normal range. After that, Grandpa Hu successfully transferred out of EICU and entered the respiratory ward to continue his rehabilitation exercise. When his pneumonia is better and his expectoration is better, the small cover of the air incision can be removed, and the inconspicuous small incision will be fine in two or three days.

"Tracheotomy is not a scourge, and many people have misunderstandings about it clinically." Cai thinks. She said that patients who are suitable for tracheotomy are usually those with lung or other diseases. Because their breathing ability is not enough, they need a connection port to connect their lungs with the ventilator. The vital signs of these patients must be relatively stable and they are expected to survive for a long time after evaluation.

"In fact, tracheotomy means that the patient's condition is getting better. To a certain extent, this is a symbol of hope. " Cai said that although tracheotomy has certain risks, this risk is controllable. More importantly, after tracheotomy, the risk of pulmonary reinfection caused by bed rest can be effectively reduced, and the success rate of taking off the ventilator is also significantly improved. Especially for the elderly, after pneumonectomy, the activity is no longer limited, which is of great benefit to the exercise of respiratory muscles.

Positive signals from ICU:

The transfer-out patients and the transfer-in patients reach a relative balance.

The number of non-COVID-19 critically ill patients has increased.

"A few weeks ago, our ICU had to add beds every day. There is no need to expand beds in these two days, and the transfer patients and transfer patients have reached a relative balance. In the past few days, more than a dozen critically ill patients in COVID-19 have improved and transferred out of the ICU every day. " The executive deputy chief physician of the Department of Critical Care Medicine of Zhejiang Darun Hospital mentioned that taking 65438+1October 9 as an example, the ICU of Zhejiang Darun Hospital and Qiantang Hospital transferred out 16 patients, and 88-year-old Uncle Shen was one of them. Uncle Shen has diabetes for more than 20 years, hypertension for 30 years, coronary heart disease 10 years, third-degree atrioventricular block, heart failure, renal failure, respiratory failure, and blood potassium is only a little over seven. After infection, he was sent to the ICU of Shaw Hospital for treatment. After a week of treatment, the ventilator was successfully removed and transferred to the respiratory ward on June 9, 65438. Guo Feng said:

The patients admitted to the ICU of Run Run Run Shaw Hospital of Zhejiang University are also quietly changing. "90%-95% of the patients admitted to ICU some time ago are critically ill patients in COVID-19. Yesterday, the number of critically ill patients in non-COVID-19 increased, accounting for about 50% of COVID-19. " Guo Feng mentioned.

6543819 October, a number of non-COVID-19 critically ill patients were newly admitted to ICU of Run Run Run Shaw Hospital of Zhejiang University. "There is a child 16 years old who is allergic to a large number of drugs, and a 25-year-old boy with hyperlipidemia and ketoacidosis, severe pancreatitis and mesenteric artery embolism."

These days, Guo Feng began to have time to consult some complicated cases through online guidance. "As a university affiliated hospital, we have the obligation and responsibility to teach."

With regard to the increasing demand for referral in primary hospitals, Guo Feng tries to keep patients with relatively controllable conditions in primary hospitals for treatment through online and offline guidance, screen out real critical cases, and implement referral at the first time.

Original title: "Tracheotomy is not a scourge!" COVID-19, an infected 82-year-old man, needed gas cutting treatment, but his family refused! Dr EICU is anxious to talk to his family twice.

Editor: Chen Yanqi

Editor: Liao Yi

Audit: Feng Fei