The grand meeting in one night wasted the energy of many directors, and many meetings in the morning needed to be postponed.

The incident happened suddenly, but the doctor would encounter various emergencies. An excellent clinician must have the passive skills to adapt to the situation at any time. So after learning about this, all parties coordinated well, and soon other meetings helped fill the gap.

Minghai’s medical seminar was not affected by this consultation.

But in a university far away in Chunming, Yunchuan, Wang Zijing, who had just been in her sophomore year, stopped the third professional class in the afternoon because of this incident. Just three minutes ago, a phone call from Licheng directly called the counselor's office and asked her to call her.

Wang Zijing studied finance. Wang Gui always believed that finance is about doing business. Wang Zijing was too lazy to explain more, but what she thought was to study hard and share the pressure for her family after graduation.

In 2004, mobile phones had already been popularized in major cities. There were many young people in universities who had mobile phones, but this had nothing to do with Wang Zijing.

My father lost most of his business last year and wanted to get back to his mouth this year, but he didn't expect Southeast Asia to be in a recession. Faced with such a situation, she didn't have so much time to enjoy herself. In order to save money for her family, she didn't ask for living expenses, and her mobile phone became a luxury.

Anyway, she took her cell phone, so she didn't have that much living expenses to call.

If you want to make a phone call, you can choose the public telephone in the dormitory building. If it doesn’t work, you can also find the landline of the counselor’s office in the administrative building. Compared to mobile phones, it is just a little more troublesome, but this method has always been used by her to contact her parents, but she has never been contacted.

When I think about it carefully, in the more than a year of college, my mother Ding Xiujuan called two phone calls at the beginning, but she didn't contact her much afterwards. So when the call was heard at this time, she always felt strange and couldn't help but think about the bad things.

Sometimes the more messy the thoughts come true. Wang Zijing tasted the taste of this sentence this time.

As soon as she entered the office, she felt the sights coming from around her, especially her counselor, with worry and helplessness on her face.

On the other end of the phone was the voice of a strange middle-aged man. His tone was low and his speech was not fast, but the content was heavy. He reported that his family was the director of Licheng Disease Control and Prevention. The second sentence made Wang Zijing's chest tighten: "After your parents arrived in Licheng on the 11th, they were isolated at Licheng Disease Control and Prevention."

"Isolation? Why is it necessary to be quarantined? Could it be..."

Even though it has been a year since the sars and even Yunchuan is not within the scope of the sars, the scene of going to Beijing to resist yi is still vivid in my mind. At first glance, the word "isolation" still gives people the illusion of sars.

The subsequent confusing description of the middle-aged doctor even worsened this illusion.

"Your father had respiratory symptoms as soon as he got off the plane, and his body temperature continued to rise. Three days later, the same situation occurred to your mother. So we took them to the Centers for Disease Control and Prevention for unknown reasons...."

"Really, really sars?"

Wang Zijing held back and didn't say anything, but tears were already spinning in his eyes disobediently.

If this is a call from her cell phone, she might classify the other party as a scammer. But in front of her was the landline of the counselor's office, so there was no need to cheat her of a girl who had no money.

In fact, the middle-aged doctor on the other end of the phone was also a little disappointed.

sars?

Lin Rong, who had just experienced a night of nervous rescue on the other end of the phone, scratched his messy gray hair and shook his head. His long-term escape from the clinical frontline made him lose his sensitivity to emotional changes in the patient's family. Sometimes, if he didn't pay attention to the wrong words, he would cause this kind of information confusion.

He just told the other party the whole process to listen to, trying to ensure objectiveness, and trying to take care of the other party's feelings as much as possible. However, he did not expect that it would have a negative effect.

Lin Rong's head was now in a mess, and there was only buzzing tinnitus in his ears besides Wang Zijing's voice.

Realizing that he hadn't made it clear, he quickly corrected: "We did think there was a possibility of sars at the beginning, but now after being admitted to the hospital, your parents did not get a zoonotic disease, but had a zoonotic disease."

Wang Zijing wiped her tears, felt a little relieved after hearing this passage, and then asked, "Then how are my parents and the others?"

"Ding Xiujuan's condition has been controlled, the treatment has been effective, and her body temperature has stabilized..."

Lin Rong said this, and gradually disappeared. He paused for a moment, trying to make the words as gentle as possible. But the brief silence had already shown the seriousness of the problem, and what was more serious was that the follow-up content of Lin Rong's speech was extremely obscure, and he had to force people to think about it in the wrong place:

"Wang Gui's situation is a bit complicated. I discussed it with your mother. She specially entrusted me to call you. She said she hoped you could come to Licheng once and see your dad."

Because Ding Xiujuan and Wang Gui rarely stay at home for business, Wang Zijing only returned to his hometown every six months. Ding Xiujuan, who knew about this situation, could not call her daughter back for some minor problems. Since that's the case, her father must be very ill.

At this time, Wang Zijing could no longer hold back the emotions in her heart. Tears kept pouring out, and the crying became louder and louder, and she couldn't stop it at all.

Seeing this, the counselor hurriedly stepped forward and took the phone call: "We will arrange for Wang Zijing to go to Licheng as soon as possible. I don't know the address of the CDC..."

“…”

"Okay, I'll write it down." The counselor took a pen and wrote down the address and hung up the phone.

After living alone in college for so long, Wang Zijing knew that crying could not solve the problem. After a brief sadness, Wang Zijing recovered a little. Her father's condition could not help much, and the only thing she could do was to go back as soon as possible.

......

At the same time, the group of people who could really help Wang Gui gathered in the 3i conference room again.

This time Huang Yuhuai has streamlined the number of people, which is on the surface for the subsequent meetings of some experts, but in fact it is to try to remove some voices that are useless to Wang Gui.

Of course, it is not that these directors who were not selected have problems with their professional level, but that they don’t have much effort to do with septic shock alone. Of course, young people like Gao Jian, Hu Dongsheng and Ji Qing who “fish in troubled waters” must also be excluded.

Next is a real fight between hand-to-hand combat. If there is a slight mistake, the patient may die.

The experts here were also mentally prepared before. Wang Gui's shock and infection were not so easy to correct. It was a normal level of success in treatment and failure in treatment. So they did enough preparations for this second major consultation early, not only slept all day, but also filled their stomachs early in the morning.

However, even with preparation, they did not expect the situation to become so serious. After the meeting at 5 o'clock in the morning, Wang Gui's condition had two phased whereabouts.

The first time it appeared at around 11 noon, when shock reappeared. This time it no longer acted alone, but instead appeared together with coagulation dysfunction, acute respiratory distress syndrome and relatively severe liver and renal insufficiency.

There is a professional term in clinical practice that specifically describes this type of offensive method: poisoning shock syndrome.

When it is manifested in Wang Gui, a relatively strange phenomenon will occur.

Because of the difficulty of breathing caused by parasites before, pleural effusion has come back, but this is just a surface offensive. What is more complicated behind the scenes is the collapse of the coagulation system and the severe electrolyte disorder.

The second whereabouts occurred 10 minutes ago. Wang Gui's body temperature quickly dropped to 37.3 degrees, and the white blood cells dropped directly from 13.9 to 3.7. Under the seemingly normal appearance, the surging attack of the god of death. Everyone here knows that the combination of cefaletinetimicin has been declared to have failed.

Yan Hong was in a heavy mood when she looked at the report she had just received.

She has seen too many patients with septic shock. Such appearances and various examination reports that are extremely disordered means that Wang Gui has reached the threshold for severe shock. Not only is the treatment difficult, but the prognosis will not be too good.

"Platelets continue to decrease, d dimer continues to rise, and potassium ions directly fall from 7 to 2.9..."

Expert b also saw the blood report and was puzzled: "Shock leads to increased lactic acid poisoning, the extracellular h concentration increases, and enters the cells along the concentration gradient. In order to maintain the charge balance, K flows out of the cells, causing the extracellular K concentration to increase, and finally hyperkalemia should be caused. How did it become hypokalemia?"

Blood potassium levels correspond to heart function and are an important clinical indicator. This detail cannot be missed.

However, several infectious disease experts do not specialize in internal medicine and cannot explain the reason. Huang Yuhuai, who is sitting in the middle, has seen such patients with septic shock because of his broad knowledge, but if he really wants to explain it clearly, he still has to rely on Yan Hong.

"There is a big problem with the kidneys."

A simple sentence shows the severity of Wang Gui.

A patient who should have hyperkalemia actually developed hypokalemia, indicating that there is a major problem with the kidneys. Hydrogen ion secretion disorders of the distal concave tubules, or potassium ion reabsorption disorders of the proximal concave tubules, will cause a reversal of the blood potassium value.

"The kidneys can't be preserved?"

"It may not be." Yan Hong sighed and looked at Qi Jing sitting next to Huang Yuhuai, "but the chance of kidney prognosis recovery is already very small."

It was precisely because the child's suggestion affected Huang Yuhuai's final judgment that the old man used Netimixing, which was more likely to damage the kidneys, that the current situation was caused. If other antibacterial drugs that were more beneficial to the kidneys were used at the beginning, maybe...

"The kidneys are most likely to have problems with septic shock." At this time, Qi Jing suddenly spoke, "Faced with patients with severe infections, there are highly drug-resistant strains, and kidney damage is inevitable."

"But what you mentioned is not effective." Expert D was more direct than Yan Hong, saying, "Sometimes you still have to listen to the elders' teachers. If you use azithromycin, the burden on the kidneys might not be that heavy."

"Teacher, don't you say that, the cephalosporin you recommended doesn't work either."

"Now we are talking about the kidneys!" said expert d.

"This depends on Director Yan's skillful hands." Qi Jing did not feel bad when the patient's condition worsened. Instead, he smiled and looked at Yan Hong in the distance, and continued, "I think if the penicillin I used before, it might have cured the infection now."

"you......"

Expert D was an anti-penicillin-protected cephalosporin group before. After hearing this, he couldn't help but get angry. He slapped the table and cursed: "Boy, don't think that some skills are lawless. When I was in clinical practice, you kid was still in the womb!"

Huang Yuhuai continued: "The doctor still needs to look forward, and holding the accountability should not appear here. Besides, Qi Jing also said before that Netimixing itself has the effect of judging the resistance of the strain, and if it fails, the corresponding antibiotic can be found immediately."

This is the important argument that Qi Jing used to "defend" Natimixing. Now the worst situation has happened and we must make an explanation.

"So now Natimixing is useless, what are you going to choose?"

"I still want to choose penicillin," said Qi Jing. "In fact, there are not many medicines that can be selected now. Penicillin is the most convenient and has the least impact on the human body. Of course, it must be without allergies."

Experts used to strongly oppose penicillin, but now it is ineffective against the generation of cephalexin, which is stronger in Gram-positive bacteria. There is another big problem with the kidneys, so he has nothing to object to: "Penicillin is just penicillin."

"What about matching?" Huang Yuhuai looked at them, "Only use penicillin?"

Expert a said at this time: "Penicillin is naturally combined with beta-lactamase inhibitors, I think we should use the mixture directly."

This is a classic clinical combination, just like the spear and shield in the hands of heavy infantrymen.

Penicillin is β-lactam, and the best way for bacteria to deal with β-lactam antibiotics such as penicillin is to secrete β-lactam enzymes and use enzymes to fight β-lactam.

In fact, bacteria can produce this enzyme, but the amount has never been large. However, the beta-lactam antibiotics used in modern times have activated the bacteria's ability to produce this enzyme, which has also produced corresponding drug resistance.

The war between humans and microorganisms is a bloody arms race.

In order to deal with the enzyme produced by bacteria, humans have developed an inhibitor of this enzyme, which has put a solid shield on beta-lactam antibiotics.

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