Decrypt the ICU behind the protective door
ICU is not a ghost gate, it is the life restart of countless critically ill patients
"I called the police! Why did you tie me up?!"
"He died of thirst, he couldn't even drink his saliva, and he was abused for a lot of money!"
"Don't hold me, I want to go home to sleep!"...These are not fictional words, but the truth that happened in the cardiac intensive care unit.
On the search engine, just enter "ICU", "What does it mean to enter the ICU", "The elderly should not enter the intensive care unit", "The survival rate of entering the ICU"... a series of related searches, in fact, show people's interest in ICU Of ignorance and fear.
In 2020, the new crown pneumonia epidemic is surging. Whether it is supporting medical teams or local war-fighting teams, ICU medical care, equipment and technology have all demonstrated their ability to turn the tide!
2021 is approaching, winter and spring are the active period of the virus, and the ICU is still expected by countless people as a ballast stone.
In the past few days, all-media reporters from the Guangzhou Daily have walked into various ICUs such as RICU, NICU, and transplantation intensive care unit, approached the care of the intensive care unit, and revealed the world behind the protective door—ICU is not a ghost gate, on the contrary, there are the lives of countless critically ill patients. Restart.
Text/Guangzhou Daily all-media reporters He Xuehua, Ren Shanshan, Weng Shuxian, Wu Cheng correspondents Hao Li, Peng Fuxiang, Ru Zhina, Zhou Mi, Han Wenqing, Pan Manqi, Li Wen
Respiratory ICU: The national team led by Zhong Nanshan specializes in tough battles
Narrator: Li Yimin, head of ICU discipline of the First Hospital of Guangzhou Medical University, and Liu Xiaoqing, director of ICU
In February of this year, 73-year-old Granny Shi, a critically ill patient with new coronary pneumonia, her condition deteriorated when she was transferred to the ICU of the First Hospital of Guangzhou Medical College. Liu Xiaoqing decisively decided to give her ECMO.
Despite the support of ECMO, Liu Xiaoqing and Li Yimin found that the tidal volume of Granny Shi's lungs still did not reach the target value during a round.
After repeated compression checks, they finally found a suitable focus point. With the help of external force, she "lifted" her abdomen, which would not affect the blood flow of ECMO, but also help her ventilate her lungs.
To this end, the ICU nursing team specially organized a "relief class", and nurses took turns to lift her abdomen 24 hours a day.
21 days later, Granny Shi successfully escaped from the "magic lung". On May 25, she was able to get out of bed and walk on her own.
Also in early February, Lao Liu, a 62-year-old critically ill patient with new coronary pneumonia, was also transferred to the ICU of the First Hospital of Guangzhou Medical College. At that time, he had developed acute respiratory distress syndrome, combined with hypertension, sleep apnea syndrome, and other foundations. The disease, coupled with the severe lung infection caused by the new coronavirus, has caused a great blow to the blood coagulation system.
After joining ECMO, a tug-of-war of "stopping bleeding and preventing thrombosis" started on Lao Liu.
It lasted for 111 days. After many trial weaning, he finally got rid of the "magic lung" and recovered and was discharged from the hospital on August 27, setting a record for the use of ECMO assistance among the critically ill patients with new coronary pneumonia who have been successfully treated globally. The record with the longest support time.
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The rescue success rate from SARS to COVID-19 exceeds 80%
In 2002, Mr. Fok Yingdong donated 10 million Hong Kong dollars to help upgrade the Respiratory Intensive Care Unit (RICU) but the equipment was still very simple at the First Hospital of Guangzhou Medical College, and build one of the largest and most advanced intensive care centers in the country. The intensive care unit was named "Yingdong Guangzhou Critical Care Medical Center".
On December 18, 2002, on December 18, 2002, the third day after the center was renovated and put into use-on the 22nd, the First Hospital of Guangzhou Medical College received a critically severe pneumonia patient transferred from Heyuan City, becoming the first SARS case reported in Guangzhou City.
Since then, under the leadership of Academician Zhong Nanshan, this ICU team has taken on the responsibility of treating every major public health emergency from SARS, influenza A, avian influenza, Middle East respiratory syndrome to this year’s new crown pneumonia war. , Won the "hard battle" after another.
Next to the beds, many machines "guard" every patient day and night-in addition to the most common ECG monitors and EEG monitors, some are also on ventilators and blood filter machines (CRRT) , Even the "Magic Lung"-ECMO (Extracorporeal Membrane Lung)...
"From SARS to new coronary pneumonia, as well as daily rescue, our average success rate is as high as 80% to 90%." Li Yimin said, this is a battlefield where there is no gunpowder but life and death.
To win people from the sword of death, to practice fast, accurate, and stable judgment and decision-making ability, the usual training must be meticulous and perfect.
"Therefore, we require the team to know all the details of the medical record within three days of the patient's arrival. We discuss whether to consult the medical record. The main detection parameters are accurate to 3 decimal places and must be memorized." Li Yimin said, yes. Thanks to the hospital's decades of accumulation and continuously enhanced clinical treatment and scientific research capabilities, the incoming patients are not without hope. On the contrary, this is a place that can bring hope to patients and families.
Cardiac Intensive ICU: The classic rescue scenes on TV mostly happen here
Narrator: Xue Ling, Director of Department of Cardiac Intensive Care, Guangdong Provincial People's Hospital
"Yijue" wakes up and finds that he is on a narrow bed with a width of one meter. The head of the bed is an instrument with a whole wall, and there are many electrode pads on his body...Most people are shocked, and some people don’t believe that they are seriously ill. The intensive care unit even "run away."
Li Jie, a CCU nurse at the Provincial Medical Cardiac Intensive Care Unit, has personally experienced such a thing.
"At two o'clock in the morning that night, a dark figure in the surrounding light ran by and was rushing to the elevator! I ran to'catch' him." The patient grabbed the door and refused to let it go, shouting "I'm okay, let it go." I..." The patient never believed that he was in post-treatment monitoring after myocardial infarction. After being sedated, several people brought him back to the intensive care unit.
CCU also has a special guardianship measure called "Access Management", which is also the cause of most "drinking water disputes" in CCU.
The kidneys like dampness, but the heart is afraid of water. The water limit in CCU is very strict.
The truth is taught to patients over and over again, but when people are really thirsty, they don’t care about the truth.
"Are you robbers? Give you 100 yuan. I want to drink more water..." I listen to similar words every day, and even the patient's family members ring the bell from time to time to complain, saying that the patient thinks he has been abused and is not allowed to drink water.
The doctors and nurses can only think of a way to give a "placebo"-water with a watering can to relieve the dry throat without delaying the condition.
The implementation of various treatment measures requires not only the efforts of medical and nursing care, but also the perseverance of the patients themselves, and the encouragement and support of family members are also indispensable.
In the provincial medical CCU, more than 1,000 patients receive critical and intensive care and supervision every year. Most of them work with medical care to fight back the disease, but some people pass away sadly.
Mo Yujing is a provincial CCU doctor. She remembers the mothers of two 3-year-old children who were transferred to two consecutive 3-year-old children on the 27th and 28th of the end of the month. They both happened to be 28 years old. They both took care of the children at night and caught a cold and stayed up late to catch a cold and caused myocarditis. Transferred to the Provincial Medical CCU.
"They live in adjacent 6 beds and 8 beds. They have exactly the same treatment and care. They all have ECMO. We are all marveled at this fate." Mo Yujing said, but the two mothers ended up life and death. Different-the mother who transferred on the 28th was successfully weaned from the machine and was soon transferred to the general ward for treatment and was rescued; the mother who transferred on the 27th died due to complications of cerebral hemorrhage.
In addition to relatives, doctors and nurses can be said to be the people who look forward to the successful treatment of patients.
But in the face of the impermanence of fate, there are also times of sadness.
Xue Ling, director of the Provincial Medical CCU, still remembers that a few years ago, a 70-year-old Guangzhou grandmother was rescued from the CCU for dozens of days. Her terminal illness was so severe that she was finally hard to reverse.
Unexpectedly, after the grandmother passed away, the family members gave Director Xue Ling a thank-you letter, which was written by the grandmother while she was sober, thanking the doctors and nurses for all the efforts and care for her.
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CCU medical care equipment
The cardiac intensive care unit has a special abbreviation-CCU. The first C originally referred to coronary heart disease, but now in South China’s largest and most important heart disease diagnosis and treatment center, the CCU has expanded to dozens of patients related to the heart. There are even prenatal and postnatal special treatments for cardiovascular problems. The most common are myocardial infarction, heart failure, arterial dissection, valvular disease, and cardiomyopathy.
CCU is different from general ICU. The heart is the engine of the human body, and it will kill if it stops. Therefore, emergency and sudden rescues often occur.
The patient was eating, and suddenly the whole body convulsed, jittered, vomited, and ventricular fibrillation occurred. The nurse and doctor nearest to him/her rushed forward, some cleaned and kept the airway open, leveled the patient, and some jumped to bed, hurry up Do chest compressions, some charge the defibrillator, and get an electric shock.
It can be said that most of the shots on TV and movies take place in the CCU.
The Provincial Medical CCU is definitely a blockbuster place, with 17 beds, each bed is equipped with complete monitoring equipment, the unit price of samples starts at 10,000 yuan; the rescue island, in the equipment room, the aortic balloon counterpulsation machine ( IABP), defibrillators, various ventilators and oxygen therapy machines, CRRT machines, PICCO machines, temporary pacemakers, computer automatic analysis electrocardiographs, arterial blood gas analyzers, bedside troponin quantification, brain natriuretic peptide, D-dimer tester, coagulation function tester; cooling device, heater, air pressure therapy device...it is dazzling.
They are weapons as well as tools, and they depend on doctors and nurses to learn and use them well.
"Many machines will take more than half a year to master." Xue Ling said.
CCU doctors and nurses are all-round talents, bedside ultrasound, hemodynamic monitoring, blood gas analysis, bronchoscopy and treatment, respiratory support, kidney replacement, etc., all kinds of equipment are easy to use.
Neonatal ICU: It is full of vitality and hope
Narrator: Zhang Huayan, Director of the Neonatal Department of Guangzhou Women and Children's Medical Care
Xiaozhi was born with only 1150 grams, which is equivalent to the weight of two bottles of mineral water. It is medically called "very low birth weight infant".
Due to poor lung development, he had to rely on a ventilator to maintain a young and fragile life, and he could not get out of the ventilator for nearly 3 months.
He was sent by his parents to the Neonatal Intensive Care Unit (NICU) in the Zhujiang New Town District of Guangzhou Women and Children's Medical Center.
Here, Xiaozhi had a particularly severe congenital emphysema, so he removed the middle lobe of the right lung and passed the "breathing barrier." The nurses thoroughly cleaned and disinfected to prevent Xiaozhi from delivering nutrients and breathing due to the deep venous catheter. The risk of infection caused by oxygen supply by the machine tube and low immunity has passed the “infection barrier”.
Here, Xiaozhi went from extremely dependent on the ventilator to evacuating the ventilator; from breathing effortlessly after a little activity to being able to tolerate passive exercise; never knowing how to breastfeed, relying solely on the stomach tube to feed milk, to sucking and feeding on her own. Learned to eat rice cereal; stiff limbs gradually recovered softness.
Medically, the neonatal period is a baby within 28 days after birth, but NICU does not only treat babies who are under the full moon.
Some even spent their first birthday here. Xiaozhi lived in NICU for 406 days. He is the oldest baby in the neonatology department and the longest in hospital.
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Premature babies rely on raising the most expensive incubator first
Unlike other ICUs, NICU is full of vitality and hope. Most of the babies here are premature babies. Until they can maintain their body temperature, the babies sleep in an incubator that simulates the womb environment and "raise" little by little during sleep. With the efforts of the medical team to treat critically ill patients while taking on the responsibility of parenting, the success rate of babies "going out" is quite high.
Premature babies must first be "raised". The most expensive incubator is worth more than 500,000 yuan. It is already possible to buy a car, and it is a luxury car.
The premature baby sleeps in an incubator, stretches out his feet comfortably in his sleep, underneath his body is a "bird's nest" made by nurses with cloth, giving the baby a sense of security as a package.
Premature babies who are severely ill and need ECMO intubation should also sleep on an open radiant table without a box or lid.
Older children who can maintain their body temperature will sleep in ordinary baby beds.
The most expensive incubator with a cost of more than 500,000 yuan has its own power supply. It also has an uninterrupted power supply during transportation. It keeps warm and moisturizes, so that the baby can be resuscitated in the incubator in the delivery room.
Fragile premature babies sleep soundly most of the time. “Less disturbing the baby and focus on nursing” is one of the nursing principles of NICU, such as feeding every 3 hours in NICU.
What kind of nursing care can be done before and after feeding. Before nursing, it is often necessary to "go through" the various processes in mind to optimize the nursing procedure; changing the diaper must be the last step of nursing.
Advanced life support equipment such as ventilators and ECMO can also be seen in the NICU.
"The characteristics of NICU babies are not just a "smaller size". The machine needs to be more sophisticated. Non-invasive and invasive ventilators are exclusively for newborns. Otherwise, the air flow and pressure in the ventilator It’s too big for newborns to bear. All ventilator monitoring requires monitoring from the end of the neonatal tracheal intubation, not at the end of the ventilator, which requires higher sensitivity." Zhang Huayan said.
Before this year, NICU could allow parents to visit inside every day. Mom and dad could give premature babies a "kangaroo hug" at the bedside. Under the special circumstances of the current epidemic prevention and control, this arrangement was suspended. Zhang Huayan hopes that the epidemic is hazy Disperse as soon as possible, and restore measures as soon as possible, because "newborn babies also have their own emotional needs."
Transplanting ICU: escorting the gift of life
Narrator: Cai Changjie, Director of the Second Department of Critical Care, the First Affiliated Hospital of Sun Yat-sen University
At 4 in the morning, a phone call awakened Cai Changjie: The 56-bed patient who was planning to undergo liver transplantation that day suddenly had dangerous signs such as irritability, unequal pupils, and suspected cerebral edema.
"You must hold him steady!" After a year, Cai Changjie still remembers this only thought.
This 30-something patient was admitted to the ICU four days ago.
At that time, he was in a second-degree hepatic coma. To save his life, he had to undergo a liver transplant, but the liver source that matched him had not yet appeared.
"He is so young and the backbone of a family. He must save his life." Cai Changjie and his colleagues tried every means to stabilize his state, buy time for the transplant, and finally waited for the appearance of a suitable liver source.
However, only four hours before the start of the transplant operation, the patient was once again in danger of life and death. In the ICU, the immediate emergency rescue continued.
At 7 o'clock in the morning, Cai Changjie and Professor He Xiaoshun, an organ transplant expert and Deputy Dean of Zhongshan First Hospital, reassessed whether the patient had a brain herniation in the ICU to determine whether the transplant could be performed.
"Once a brain herniation occurs, even a liver replacement cannot save the life of this legitimate man."
The liver transplantation finally proceeded as usual, and the liver donated by the volunteers was re-applied in the body of the 56-bed patient, restarting his life.
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Keep your life first and buy time to find the cause
Organ transplantation is often hailed as "the brightest jewel in the crown of the kingdom of surgery". Surgery specialists play a key role in the "safflower" and determine the success or failure of the operation. The doctors and nurses of the transplant ICU will accompany transplant recipients with organ failure. After the preoperative waiting period, to gain time for the opportunity of organ transplantation, it is also necessary to help patients bravely break through the rejection and infection barriers after surgery.
The First Affiliated Hospital of Sun Yat-sen University is constantly writing the "first" record of the history of organ transplantation. Behind the transplant ICU is 100% effort for patients to have even 1% hope of survival.
"In 1992, our hospital's ICU was just established. At that time, many surgical colleagues didn't know what ICU was, thinking that there were only nurses." Cai Changjie recalled that the most important thing in the ICU was organ support. The patient suddenly fell into a coma and his blood pressure could not stabilize. Suddenly no urine, sometimes it takes time to find the cause, and the task of the ICU is to save life first, buy time for the doctor to find the cause, so that the patient can be treated.
Compared with other patients whose lives are hanging by a thread, the challenges brought by liver transplantation patients are more special: they are often in their prime of life. After the liver transplantation, their bodies will reject "new partners", and rejection, infection, etc. may blow their lives at any time. Candle.
The ICU is the place where the most serious patients are in the hospital. Therefore, people often say that “you will die after entering the ICU”. Cai Changjie said that indeed many patients in the transplant ICU have multiple organ dysfunctions and high mortality rates. This is why every time they are rescued A life, ICU medical care will be particularly fulfilled.
Whenever a patient passes away unfortunately, the doctor will analyze the cause of death. “If the patient died because we did not observe carefully and did not seize the opportunity for treatment, it would be unforgivable.” Cai Changjie said.