Author丨Ji Yuanyuan
Editor丨Zhu Ping
Picture Source丨Tu Chong
As the peaks of infection are arriving in various places, many cities are beginning to face the challenge of peak severe cases.
Especially under the increasing pressure of fever clinics, emergency departments and severe admissions, medical staff from all over the country have always stood their ground and continued to bear the burden.
Recently, Professor Wu Chao, chief physician of the Department of Infectious Diseases at Gulou Hospital Affiliated to Nanjing University School of Medicine and director of the Institute of Virology and Infectious Diseases of Nanjing University, also said in an interview with a reporter from the Century Economic Report that judging from the situation of Nanjing Drum Tower Hospital, 70%-80% of the medical staff were reduced within half a month. Many doctors were working while sick and rushed back to the front line before their fevers subsided. At present, the hospital's emergency department, fever clinic, and intensive care unit are saturated, and their capacity has reached its limit.
"After three years of fighting the epidemic, hospitals and doctors have gone through many battles and are fully mentally prepared. They can undoubtedly meet the biggest challenges and provide scientific and standardized treatment for special groups." Professor Wu Chao said.
Right now, these most ordinary medical staff are marching day and night to help each other, and together they have built the city's strongest "fortress" to fight the epidemic.
17-year-old myocarditis-positive patient turns the corner
As night falls, in the fever clinic of Beijing United Family Hospital, many medical staff return to the battlefield as soon as they turn negative and join the fight against the epidemic at night in the fever clinic. Recently, the number of fever outpatients here has increased by 20 times. Nervous patients, anxious family members, busy medical staff, one "sleepless night" after another.
Recently, a case that deeply affected Yang Qiuying, the chief administrative officer on duty, was at 9:00 one night at the pre-examination and triage office of the hospital. Yang Qiuying found a 17-year-old boy covering his chest with his hands and having difficulty breathing. The boy was tall and looked very strong, but at this time he was lying on the waiting chair and unable to stand. Combining the patient's symptoms and the hospital's COVID-19 treatment knowledge training, Yang Qiuying was sensitively aware that the patient's condition was critical and that serious disease complications might occur, so he urgently went to the fever emergency room doctor Li Hongbo who was on duty that night for evaluation.
21:10, Dr. Li Hongbo freed up his hands from the busy fever emergency treatment. After quickly assessing the patient’s symptoms and understanding the condition, he decided to admit the patient urgently. After comprehensive auxiliary examinations, it was found that the patient's various indicators were abnormal: positive for COVID-19, heart rate 7135 beats/min, respiration 40 times/min, blood pressure 90mmHg/57mmHg, troponin 750,000 μg/L, brain natriuretic peptide more than 40,000, liver and kidney function damage, low sodium and high potassium... Based on the examination results, Dr. Li Hongbo judged that the patient was in critical condition and required consultation by experts from the heart center.
23:19, Dr. Bai Shuling from the Department of Cardiology diagnosed the patient with fulminant myocarditis based on the ultrasound examination results of "cardiac ejection fraction (EF value) of only 30% and pericardial effusion ". The patient was in critical condition and could suffer from fatal arrhythmia and acute heart failure at any time. In the clinic, the patient's condition continued to deteriorate, and his blood pressure, blood oxygen and other indicators dropped significantly. Dr. Bai Shuling gave him continuous vasopressor drugs and high-flow oxygen inhalation. He also assisted the team to transfer the patient to ICU for treatment and provide intensive care and life support.
According to a reporter from the 21st Century Business Herald, among the many fever patients every day, many of them are already in critical condition when they are admitted to the hospital. Among them were old people, children, and young adults. Clear access to medical treatment for critically ill patients is extremely critical in the treatment process. With the continuous symptomatic treatment and emergency rescue by the medical team, the patient successfully grasped the golden window for treatment.
The patient is still in the intensive care unit, but his condition has stabilized. The patient's mother said: "We are lucky to have entered the fever clinic in advance, otherwise the child may have died. Thank you to the doctor for the timely admission!" Afterwards, according to Dr. Bai Shuling, fulminant myocarditis is an extremely dangerous cardiovascular emergency. It is mainly initiated by upper respiratory tract infection or intestinal infection, which can lead to serious cardiac events, such as cardiogenic shock, malignant arrhythmia and even death.The onset of symptoms is particularly acute and can reach its peak in as little as a few hours. The fatality rate is relatively high, with sudden death being the main cause of .
"Fulminant myocarditis is the most serious and special type of myocarditis . Its main characteristics are sudden onset and extremely rapid progression of the disease. Patients will soon develop hemodynamic abnormalities and severe arrhythmia , and may be accompanied by respiratory failure, and liver and kidney failure, and early death. The rate is extremely high. Because of this, this disease has always been the most difficult problem for cardiologists. Even in countries with more abundant medical resources, the early mortality rate is still more than 50%. "Bai Shuling said that the smooth transfer of patients was due to the efficient cooperation of the medical team, which achieved early identification, early diagnosis, early prediction, and rapid transportation, seizing the precious rescue window.
Experts remind that the early symptoms of fulminant myocarditis are very similar to those of infection with the new coronavirus or influenza. For example, all three may have symptoms such as headache, fever, cough, chills or nasal congestion, and muscle pain. If patients infected with the new coronavirus or influenza experience difficulty breathing, chest tightness, palpitations, or slight chest pain, this is a reminder that the disease has affected the heart. If more serious symptoms occur, such as fainting, profuse sweating, drop in blood pressure, arrhythmia, etc., you should go to the hospital immediately.
When diabetes encounters the new crown
As the peak of infection approaches, emergency rooms, fever sentinel sites, pediatrics, and general practices are already overcrowded, and inpatient departments are also becoming saturated. They are experiencing the dual test of shortage of medical staff and surge in patient volume. What is even more serious is the increasing number of high-risk patients. In addition to the elderly group over 70 years old, another group of people cannot be ignored, that is, patients with a history of diabetes.
Recently, the emergency department of Shanghai Jiahui International Hospital admitted such a Grade I patient. The patient was in a coma when he was admitted to the hospital and was immediately sent to the resuscitation room for rescue. At that time, the patient was in blood pressure shock (Bp71/40mmHg), and the peripheral blood sugar was too high to be detected. The blood gas analysis showed severe metabolic acidosis (PH 6.89) and severe hyperkalemia (6.8mmol/l), and the venous blood sugar exceeded 50mmol/L.
Family members reported that the patient was 75 years old, had a history of diabetes and high blood pressure for many years, and had poor blood sugar control. He mainly relied on insulin injections and oral hypoglycemic drugs for daily treatment. After being infected with the new coronavirus, the patient developed symptoms of fever, loss of appetite, and eating less. The home blood glucose meter could no longer measure blood sugar, and the effect of increasing the insulin dose was not good. Two days after the infection, the patient developed vomiting and diarrhea for one day. The next day, his family found that he was unconscious and sent him to the hospital. His condition was extremely critical. Emergency Department Dr. Jiang invited Dr. Pang from the ICU and Endocrinology Department for consultation, and at the same time borrowed monitoring equipment from the Ultrasound Department. At the same time, he and the emergency medical team prepared deep vein expansion and rehydration, striving to stabilize the patient's vital signs as soon as possible so that he could improve the CT examination later.
Doctors from the ICU and endocrinology department quickly arrived at the emergency room. After consultation, the patient was diagnosed with diabetic ketoacidosis (DKA) coma, severe dehydration, severe hyperkalemia, anuria, and renal insufficiency. The emergency department immediately used norepinephrine to increase blood pressure, and simultaneously performed a series of treatments such as fluid replenishment and volume expansion to lower blood potassium, low-dose insulin to lower blood sugar, acid correction, anti-infection, and catheterization. After DKA corrected blood sugar control to a safe range, the patient finally regained consciousness. Considering that the patient still had problems such as pulmonary infection , elevated cardiac enzymes, and cardiac insufficiency, the hospital admitted him to the ICU ward for continued treatment and has been successfully transferred to the inpatient department.
According to Dr. Pang Can of the Department of Endocrinology of Jiahui Medical, a meta-analysis study showed that diabetes may significantly worsen the clinical course of new coronavirus . Compared with non-diabetic patients, diabetic patients are approximately 2 times more likely to develop severe COVID-19 and approximately 2 times more likely to die. 2 Type 2 diabetes patients themselves have underlying chronic inflammation, which is related to insulin resistance. At the same time, patients with diabetes often have other chronic diseases such as hypertension, obesity, cardiovascular disease, dyslipidemia, etc., which may also aggravate the poor prognosis.Although the mechanism is not yet clear, on the basis of existing chronic inflammation, along with the enhanced inflammatory response to new coronavirus infection and the increase in viral load , it may lead to an extreme systemic immune response and worsen the condition.
Elderly patients with underlying diseases have always been the most vulnerable group in the COVID-19 epidemic. Dr. Jiang Shaowei of the emergency department has also encountered many critically ill patients related to diabetes. Hyperglycemic crisis, including diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar syndrome (HHS), are two important acute complications of diabetes. Diabetic ketoacidosis (DKA) is a common and potentially fatal acute complication of diabetes caused by relative insulin deficiency. It is more common in patients with type 1 diabetes and type 2 diabetes with poor pancreatic islet function. In patients with pre-existing diabetes, DKA may be a common complication of severe COVID-19 and a marker of poor prognosis. Research shows that COVID-19 can induce severe manifestations of diabetes, including diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). Critically ill COVID-19 patients may develop severe insulin resistance, and insulin resistance may improve rapidly after COVID-19 is relieved. In addition, some hospitalized patients are also prone to long-term severe hypoglycemia.
Therefore, after being infected with the new coronavirus, patients with a history of diabetes, regardless of age, need to actively prevent hypoglycemia, severe hyperglycemia, and DKA.
Experts remind that on the one hand, monitor blood sugar well. Blood sugar may fluctuate when infected with COVID-19. At this time, it is necessary to increase the frequency of blood sugar monitoring, including fingertip blood sugar at fasting, 2 hours after three meals, and before going to bed. Diabetes patients with asymptomatic infection or mild symptoms can choose to quarantine at home if their blood sugar control is stable. Pay attention to ensuring adequate sleep, regular work and rest, avoiding anxiety, ensuring a reasonable and nutritious diet, exercising indoors according to local conditions, and strengthening self-monitoring of blood sugar. If high fever persists, blood sugar continues to rise, or even cannot be detected by a home blood glucose meter, or symptoms such as vomiting, diarrhea, difficulty breathing, shortness of breath, etc. worsen, you must go to a medical institution for diagnosis and treatment in time to avoid delaying the condition.
On the other hand, standardize the use of hypoglycemic drugs. During COVID-19 infection, it is even more necessary to use anti-diabetic drugs regularly. Insist on taking the medicine and do not change the medicine or stop the medicine at will, especially patients taking insulin. Do not stop taking insulin at will. If you have gastrointestinal symptoms and cannot eat normally, you need to increase or decrease the medicine according to the blood sugar situation in time, or seek medical treatment in time to seek adjustment of the treatment plan. In addition, most liquid cough preparations contain sugar, which may have a certain impact on blood sugar. It is recommended to prescribe sugar-free cough preparations. To stay hydrated, take 8 ounces (approximately 250 mL) of carbohydrate-free fluid (e.g., water, broth) every 1-2 hours as needed to replace fluids lost through urination and AWD.
In summary, for patients with diabetes, safe and effective blood sugar, blood pressure, and blood lipids control may help reduce the severity of COVID-19. While staying at home, you should also formulate a scientific diet and exercise plan and stick to the plan to ensure adequate sleep and a good mood, so as to ensure safety against the epidemic.
E N D
Editor of this issue Liu Xueying Intern Yu Xinyu
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-