Septic shock has several nodes where the condition worsens and poor prognosis are present.

One is the abnormal amplitude of potassium ions in the blood electrolyte. Whether it is increased or decreased, the further the blood potassium value is from the normal value, the more the severity of shock. The other is the thoracic and abdominal effusion caused by systemic organ damage. Once the thoracic and abdominal effusion occurs, it means that the shock is already very serious.

The third is the change of dic.

dic is not a single disease, but a complete set of complex pathological syndromes. At first, the blood in the body will have a hypercoagulant state due to various causes. After the coagulation system is over-consumption, the platelets will fall and then enter the bleeding period. Until the tendency of widespread bleeding in the whole body occurs, the contradiction between hypercoagulation and non-coagulation will continue to exist in a body.

The simple hypercoagulation period is often short-term. When discovered, the patient has already developed purpura spots, which means that the bleeding period is reached.

The range of purpura purpura during the bleeding period determines the direction of shock to a certain extent, but the situation of purpura combined with skin necrosis of the lower limbs like Wang Gui is probably different from the coagulation necrosis caused by ordinary dics.

After all, Lin Rong is from infectious diseases. He has seen many cases in Huang Xinghua's research institute in his early years, and his strength is not weak. However, in recent years, he has been to such a small place as Licheng, and his old capital is almost gone, and he looks like a quack doctor.

In recent days, he has devoted himself to Wang Gui, which has also helped him regain a lot of memories and strength.

He has seen this kind of purpura before, so he feels familiar when he sees it, but if it is confirmed or not, he still has to ask Minghai and other experts to ask clearly.

"Fulfilling purpura." Huang Xinghua said the word Lin Rong was thinking, and it also meant the failure of the second antibiotic treatment. "It seems that amoxicillin clavulanate potassium also has no effect on this bacteria."

Lin Rong stood at the door of the intensive care unit and turned on Wang Zijing's gaze and asked in a low voice: "What should I do next?"

Huang Xinghua frowned, always feeling a little strange.

He raised the teacup in his hand and put it down. After he hesitating for a while, he still looked at the young man beside him: "Don't always look like I won't let you speak, just say whatever you have."

Qi Jing put down a book in his hand and said, "I want Director Lin to go back to see the patient."

"Do you want him to see the situation of other purple spots?" Huang Xinghua sighed and said to his phone, "Lao Lin, go and see again. Maybe the situation is not that simple."

"have a look?"

Lin Rong also wanted to see it, but he was afraid that Wang Zijing could not bear it, so he gave a wink at the nurse's desk. The latter was also an old nurse who had been working in clinical practice for a long time. He immediately came to Wang Zijing with understanding and said, "Family, the visiting time has come."

"Time? When?" Wang Zijing frowned.

"The intensive care unit has a visit time regulation, and only one family member can enter at a time, and the visit time is only 15 minutes." The nurse turned around and looked at the electronic digital clock behind her and said, "The time is up."

Wang Zijing was puzzled. These fifteen minutes were too short.

The seriously ill father was left in such a cold heavy cell, and there was no one to take care of him. Looking at the doctors and nurses around him, there were only three people in total. How could she feel at ease: "What are your regulations? Where are there so unkind people?"

Common family reactions are just a little tough in their tone, and they should not understand the meaning of this provision, and they are not yet at the point of not listening to advice.

The nurse is just a message after all, and the specific explanation depends on Lin Rong.

He leaned sideways against the nurse's table, and in just one minute he had put himself in a disposable surgical cap, disposable plastic gloves, and two layers of masks, almost fully armed.

After doing all this, he explained: "Xiao Wang, don't blame us, there is nothing we can do about it. We all carry all kinds of bacteria, especially those who have just gotten off the long-distance bus, and I don't know what pathogens I have written on them. Your father is very weak now and can't bear it with a streptococci. If there is another infection, we will be even more unable to deal with it."

Wang Zijing did make sense, but she still felt a little uncomfortable in her heart: "But..."

"Don't, your dad is in a bad situation now. At this critical moment, please help me and don't affect our treatment."

As far as she said this, Wang Zijing had no choice but to retreat and watched the door slowly close. She didn't expect that Ding Xiujuan would just take a look at it.

Lin Rong didn't want to drive out people, but now the situation has to be forced to do so. After seeing the changes in Wang Gui's back and buttocks, he was even more sure that this was an excellent decision.

"Director Huang is a blood blister."

Huang Xinghua and Qi Jing thought of this before.

Fulking purpura is similar to DIC, which includes both infarction and necrosis and subcutaneous bleeding. Wang Gui has a coagulation disorder and will not form large necrosis foci. The opposite is the large-scale subcutaneous blood blisters.

However, the final outcome of the blood blister is epidermal necrosis, but the paths of formation are different.

Hearing this, Huang Xinghua couldn't sit still and asked quickly: "Has it been integrated?"

"Not yet, it's a scattered bubble."

Lin Rong breathed some relief again, feeling that his life would be scared by Wang Gui. In just two and a half days, he had touched all the things that had the most serious septic shock. I'm afraid he was in good health, otherwise he would not be able to withstand it now.

Huang Xinghua is also tired.

At that time, it was entirely due to the responsibility of preventing and controlling infectious diseases, so I took on this chore. Now I didn’t expect that Wang Gui would almost become his own patient as he was in charge of the management: “You prepare the latest blood test report, and I will find those doctors.”

"The blood has been sent for testing."

"Okay, I'll call you when the people here are almost together." Huang Xinghua thought for a while and added, "Look for me, it's very likely that something happened to this patient halfway."

"Yeah, I know."

Lin Rong hung up the phone and called two other subordinate doctors on duty to handle the matter at night. And on Minghai's side, the third consultation began with yawns. After only 13 minutes, more than a dozen directors and experts who had the last consultation gathered in the 3i conference room again.

"It's quite fast to apply for the conference room this time." Yan Hong had just finished taking a shower and walked in with her wet hair. "It's not like the first time, I've been waiting in the lobby on the ground floor for a while."

"Director Yan, you misunderstood." Seeing Yan Hong present, Huang Xinghua quickly turned on his cell phone and called Lin Rong, "Actually, Qi Jing and I didn't leave at all."

"You haven't gone back?"

"I want to report to the above that people are infected with Streptococcus suis. As for him..."

"I'm just bored." Qi Jing put down a book in his hand and said with a smile, "It just so happened that Director Huang was missing a companion, so I came here to accompany him and pay attention to Wang Gui's condition."

"Pay attention..." Yan Hong couldn't help but complain in her heart: This attention paid attention to the fulminant purpura.

On the other side, the phone was already connected, and Huang Xinghua asked quickly: "How is the patient now?"

"The situation is fine." Lin Rong said.

"Is the blood report coming out?"

Lin Rong didn't say it in detail, but just gave a rough feeling: "It's similar to before, do you still have to change antibiotics?"

"There is no rush to antibiotics, and it's useless if it's urgent." Huang Xinghua looked at Yan Hong in the distance, "Director Yan, you are still good at this, please tell me."

Yan Hong nodded: "The patient's limbs are still cold, right?"

"Well, microcirculation is still not good," Lin Rong said. "I feel that the patient has a refractory shock. I have been struggling for two days, and the systolic blood pressure still cannot rise."

“How about electrolytes?”

"The lactic acid has been corrected, the pH is not abnormal, and the potassium ions have also been replenished."

"I was in shock for two days, and it was useless to correct these. Add the amount of low-molecular dextran 40 glucose, first put two large bags of 1,000 ml intravenous drops to reduce platelet adhesion, inhibit red blood cell condensation, and improve microcirculation." Yan Hong said while combing her hair with a comb, "Then use glucagon to improve and correct acidosis. Add amber hydrogen test to 200, and it will be 10 hours of slow drops."

"That..." Lin Rong couldn't keep up with the rhythm and asked quickly, "How much does glucagon give? 1mg?"

"Brother, this is shock, not hypoglycemia!" Yan Hong rolled her eyes and said helplessly, "First give 5mg of vein to see the situation in half a minute. If there is no reaction, then 5mg. Give 4 units of insulin hedge for every 5mg, and you have to supplement 100ml of 10% glucose. By the way, don't forget to supplement potassium."

"good!"

Yan Hong faced this two internal medicine knife, so he could only teach step by step: "After the 10mg speed drop, use 10mg glucagon plus these ingredients every two hours to slowly drip intravenously,"

"I've written down all of them."

"The next one is fulminant purpura." Yan Hong tied her hair with a big ponytail, muttering the name of the medicine in her mouth while leaning her fingers, and finally gave the answer: "You should not have recombinant human activation protein c here."

Lin Rong felt a headache when he listened to a long list of professional terms: "No."

"Then I don't have any good idea, I can only see the patient myself." Yan Hong sighed and threw the topic back to Huang Xinghua, "I'm done here, I have to rely on you in the future."

After all, Wang Gui’s problem is still infection. Although shock needs to be treated, the cause of the disease is not cured, and no matter how strong Wang Gui’s body is, he can’t stand it. Now the shock treatment has effect, at least there is no problem with electrolytes, and the heart can still tolerate it. Although the patient’s kidneys have lost most of its function, it can still be maintained with hemodialysis.

The rest is antibacterial.

"Tell me what you think." Huang Xinghua held the antibiotic antibacterial spectrum coverage map drawn in his hand. The antibiotics used almost covered most bacterial species, and the remaining ones were too biased.

"Try tetracycline?" expert b replied, "Qi Jing said before that tetracycline is likely to be resistant, but now there are not many drugs available. We can use doxycycline. Although yuenan has been used to treat cholera, it is still an option at least."

"Don't consider tetracyclines for now."

Huang Xinghua shook a newly printed case report in his hand and said, "Wang Gui's cousin Yang Yinghua was taken to a local hospital in Hanoi by an ambulance when we were in the second consultation. The same symptoms of meningitis, the purpura purpura were used, and doxycycline was used from the beginning."

After saying this, the facts are clear, tetracyclines are completely useless.

"It's better to use macrolide." Expert a suggested, "In fact, the only thing left is macrolide. I think it's more reliable than the azithromycin mentioned earlier. Among macrolides, clarithromycin is the most useful for Gram-positive bacteria."

This is basically the last medicine that Licheng Disease Control can produce, and it is also the type of medicine they left behind after three consultations.

In fact, even Huang Yuhuai, who was silent on the side, had to admit that it was really time to run out of ammunition and food. If he hesitated, the patient would be taken away by the god of death at any time.

"But macrolides not only cannot enter the blood-brain barrier, but also it is difficult to maintain the blood drug concentration." At this time, Qi Jing's voice sounded in the corner, "and macrolides are also common drugs for yuenan. And just half an hour ago, Yang Yinghua had already replaced clarithromycin with our suggestion. There was no need for Wang Gui to use it again."

"this......"

"There is still such a way?"

"If it is invalid, wouldn't it be a sacrifice to one person?"

Several experts really couldn't agree with Qi Jing's approach: "Are you doing this too much?"

"Excessive? This is the treatment you gave, which is very fair to Yang Yinghua. But I object to this treatment, which is also fair to Wang Gui."

Qi Jing knew that he was suspicious of quibbling, but at this time, it was very likely that neither of them could save their lives without special means: "Yang Yinghua's situation is even more serious than his cousin. Now hesitates. He is in a state of shock. He has a heart problem and has stopped beating twice. If he hesitates, none of us can save it!"

Huang Xinghua stood on Qi Jing's side at this time: "I made Yang Yinghua's clarithromycin, so let's think of a solution here. If it really doesn't work, we can wait for the result from Yuenan."

"You can't wait, you must actively treat antibacterially!"

"Dad, do you want to use clarithromycin for Wang Gui?" Huang Yuhuai rejected his son's conservative approach.

Huang Xinghua looked at his father. If even his father insisted, he would never be able to defend Qi Jing's idea. The two had reached a consensus before, and Qi Jing also agreed.

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