The Revelations of the War Epidemic . . . Zhang Liyang: Transplantthets to Wuhan.

When Secretary Zhang Liyang led the second batch of medical teams from Beijing Concord Hospital to Wuhan on February 7, it was the "dark" moment of the development of the wuhan epidemic, with the number of confirmed cases reaching more than a thousand, sometimes even two or three thousand people, and a large number of seriously ill patients flocking to the hospital!---- Looking at so many seriously ill patients waiting for beds, income hospital patients and lack of effective treatment, Rao is a hundred wars of Concord experts also gave birth to a "cannot fight" sense of powerlessnessOn the 9th floor of the Sino-French New Town Hospital building at Tongji Hospital, the first members of the Concord medical team, with the assistance of colleagues at Tongji Hospital, completed the rehabilitation of the critically ill area in just 48 hours and began to receive patients on 5 FebruaryOut of trust in Concord Hospital, the most important critically ill patients sent here are the last stops they have taken for their lives32 critical beds soon filled with patients, in Zhang Liyang led the second batch of medical team arrived on the 7th, before the first batch of 21 medical team members have been in this "carry" for 48 hours, Zhang Liyang heart understand that night they have to topOn the evening of February 7th, the wind and rain were brought up, and the cold weather added to the fear in our heartsAt 7 p.mthat night, more than 100 large troops began to train in rooms, and that night the first shift of medical staff had already rushed to the hospital"In the face of unknown diseases, in the face of chaotic environment, in the face of thick protective clothing tired figure, we have no back spring magic hand, we can only do to follow the laws of science, carry forward the tradition and spirit of the century-old Concord, return to the essence of medical treatment, return to the effective treatment of disease." As the leader of the last national medical team to leave Wuhan, Zhang Saidan admitted that until she led all the team members back to Beijing many days later, she gradually came out of that kind of war "epidemic" state, in order to face the health of the field of interviews, calmly review and sum up the 81 days of the rescue of the quenched association and experienceConcorde heirloomin in the new crown virus is the most rampant "to dark" period, the patient's life and death is often only in a flash"At the highest level of workload, 32 beds were filled with 28 ventilators..." "Although the whole body was exhausted, most of the patients' conditions were still deadlocked, and I really felt the helplessness of being a doctor," the co-medical team wrote in their anti-epidemic handbook"Compared with the ordinary ICU, the critically ill ICU in the New Town Hospital District of Sino-French is particularly difficultFirst of all, critically ill patients to the end of the stage have difficult to correct respiratory failure, many patients combined with more than a multi-system functional failure; Core group: From disorder to order" to Wuhan, our first task is to let everyone from the initial state of chaos to orderly workZhang said, "In the face of the big test, our countermeasure is to establish the core group, and at the same time set up the core group regular meeting system." The core group consists of 21 members, including multidisciplinary experts, head nurses, secretaries of the interim party branch, as well as researchers and inspectorsEvery night at 8 o'clock is the core group meeting time, no matter how hard people work during the day, to the point of time to meet on timeThe content of the meeting revolves around two aspects, but also when the medical team set out, President Zhao Yupei gave us two orders: one is to do our best to treat patients, the other is to ensure the safety of the team members, bring the team members back a lotZhang said The topic of discussion at the core group meeting is often the resumption of the day's work, but also the shift of care cooperation, but also patient-centered, around the needs of patients and problem-oriented case discussion "We always start from the most critically ill patient situation, from the morning experts led the room, arranged the day's treatment plan, to the day down how the situation, what can be done, and what can be used, we immediately and the first line of doctors, nurses docking up." So we often after the regular meeting and then rushed back to the ward, that night to adjust the treatment plan "Such multidisciplinary discussion, not only clinical multidisciplinary collaboration, but also the combination of medical care, is the combination of clinical medicine and basic research, is the combination of medical and management, it can be said that the core team is both medical and management MDT, in the Concord Hospital as a whole in the action to play a vital role in the collective strength to overcome all difficulties." In addition to the group efforts to treat patients, the core group also set up a wartime work model, relying on the backbone of the establishment of a system, the development of the work of standard operating procedures, combing the work list, so that everyone should be clear about their work responsibilities Over the past two months, concord medical team developed the prescribed system, including workflow, diagnosis and treatment routine, medical records writing, three-level room inspection, such as nearly 40, formed a set of scientific norms of the rules and regulations system, and closed-loop management, so that the forward team members have rules to follow The three-level room inspection system has always been the Concord Hospital's "heritage", the medical team along the lease, the establishment of a "check room professor, second-line doctors, first-line doctors" three-level room inspection system Professor Chafang has SARS diagnosis and treatment, critical management and other aspects of rich experience, medical team members covering the ICU, internal medicine ICU, respiratory and critical medicine, cardiology, nephrology, digestive medicine and other departments, giving full play to the national team's comprehensive diagnosis and treatment advantages Through consultation, they develop a treatment plan for each patient is individual, all-round support treatment, including respiratory support, circulation support, nutritional support, for the prevention and treatment of infection, as well as for the patient's immune disorder seduction treatment, blood adsorption, blood filter treatment, Chinese medicine In addition to the morning consultation of the team of experts, the medical team has 24 times connected to the rear, is to provide each critically ill patient with the right supportive treatment "The scheduling is a technical work, and we're also brain-driven Zhang Liyang said that each shift is composed of first-line, second-line, third-line doctors, the first line is a young resident, the second line of the main doctor, the third line is the town's expert professor, each team is multidisciplinary matching, in which the department of intensive medicine, infection, respiratory medicine is undoubtedly the backbone of the team Everyone from the Concord Hospital of the various departments, some people do not even know each other, but through a clear division of labor, clear job responsibilities, we have a clear job to do The medical team implanted the Concord ego into the ICU ward in Wuhan, after the early shift every day, each professor will enter the "red area" (pollution area) ward to check the room, to the patient's bedside to master a hand of information, according to the patient's daily changes in the condition of the consultation On-duty first-line, second-line doctors can not deal with changes in the condition, 24 hours can be contacted with the third line, to ensure the quality of medical care List management: to ensure medical homogenization because of wearing heavy protective clothing, medical staff per shift in the first line of working time can not be too long, and multiple shifts on duty, how to ensure that health care workers in thinking, action always maintain homogeneity, synchronization? The work list becomes a very important management tool Standardize and format every means of implementation, so that everyone's treatment and management are in the same professional and orderly state "The work list is a consistent way of managing Concorde, especially for this provisionally formed young multidisciplinary team Zhang said, "For the new crown pneumonia outbreak, our list of work is updated with the understanding of the disease, such as the general situation of patients to add a lot of epidemiological history of content." Another such as the patient's transfer out, or even after the patient's death after the farewell process, to the family to appease, the content of the phone call and so on are included in all aspects "Zhang Liyang specifically mentioned the family members of the deceased patients told that in the face of grief-stricken family members, medical staff often tearful eyes, simply can not say, how to do?" We have also compiled the contents of the death notice into a standardized list, including the introduction of the patient's condition, how we have done our best, how the patient died peacefully at the end of his life . We train medical staff to give a full account to their families on the matters on the notice, and to complete the full process of notification, even in special circumstances "Put on the robe, will have to save a few lives back in the war "epidemic" early, the biggest test is not to know the disease, in the absence of special drugs, seriously ill patients like the initial flood of the initial stage, when the doctor has nothing to rely on, can only bare-handedly to fight the virus, Concorde can rely on is the Concord "smoked" out of the basic work, the most conventional medical "three-base three strict." To understand the disease accurately and comprehensively, it is necessary to go to the patient's bedside, as much as possible to observe the patient's condition changes, to understand the patient's response to treatment, and patient zero distance contact, is not only a humane care for the patient, but also a process of understanding the disease is particularly important So concord hospital's medical team asked that any doctor and nurse should go to the red zone, to the patient's bedside, even the unconscious patient, after the implementation of treatment to shout and call him, to see if he can hear, treatment has not improved "When you put on your robe, you have to make more contact with the patient and save a few more lives, and that's what we're saying." Zhang said The medical team at Concord Hospital is the largest team with medical staff per class, each with more than 20 per class In order to ensure the continuity of patient treatment, they implement a "bed-to-person, bed-to-group", fixed doctors and nurses to take charge of a patient, so that long and close observation of the patient, to ensure that their treatment plan reflects the level of the entire team, rather than the individual level of the doctor on duty As far as possible, the medical staff will try to move all the medical care to the front, strengthen the overall medical treatment, the overall care, as well as the cooperation between the care and complement each other, we fully support the patient's multi-organ multi-system functional support and treatment, for the recovery of the patient's immunity and the reversal of the disease to win time and opportunity "Our doctors and nurses often stick to the patient's ear and talk to him, according to the change in the condition of timely to do a variety of tests, always pay attention to the change in laboratory value, every young doctor, nurse to their care of the patient's situation is well aware of the progress, it can be said that everyone is an innovator." Speaking of the growth of young players, Zhang Liyang is not without pride "I often wonder, what's the difference between the health care providers in different hospitals?" In Zhang's view, we are in fact the same level of macro-theoretical knowledge, but how to put the technology and standards in place, it reflects the gap between the difficulties of knowledge "What we're on the front line is the system, the standard, the standard, the landing of our grasper is the inspection and evaluation "For example, spitting, symbolic spitting and really spitting out, how to distinguish between the two?" Concord Medical Team requires each nurse to come to practice, by the most experienced chief of intensive care department in the side assessment, and bedside training, hand-held teaching Such first-line teaching has led to a marked improvement in the skills of nurses from different specialties The more patients, the most serious busy moment, the more need to "grind the knife not mistakenly cut wood work." Zhang Liyang led the team members in Wuhan to organize 37 "epidemic" line classroom, in accordance with the "clinical needs, timely training what" principle, so that the first-team players to supplement new knowledge, master new skills, as multi-faceted, one-time victory and responsibility Many of the skills they learned the first day were used on the clinical line the next day For the new crown virus, even for the serious illness experienced countless Zhang Liyang, admitted that the virus is still not specific drugs and treatment "But without special drugs, is there no rule of law?" Zhang asked In her view, the treatment is our understanding of the structural function of the body, the outbreak of resistance war, encounter war, torture is our usual understanding of the disease, the test is our "three-base three strict" peacetime kung fu By putting the "three bases and three strictly" in place, you can change the medical outcome When each treatment is used, there is a degree and quantity of grasp, which is the skill of medicine For example, the ventilator, when the use should not delay, the end of the time do not delay "We have been calling on the core group and all the players, rigorous refinement, hard-working dedication of the association and spirit is really not an empty word, in this spirit has been edified out of the Concorde, at a critical moment to show their strength." In those days of Wuhan ICU, even if our status quo has not changed, our means have not changed, but the survival rate of patients significantly improved, patients survived more and more, even if the doctor has been sentenced to death patients, the results really survived This is a medical miracle Concord temperature first expedition team member, young M.D Yan Nanze wrote in the anti-epidemic diary: "Although the patients are many, the disease is serious, the environment is new, the protection is thick, but the entire medical team has always had a constant requirement, that is, Concorde standards." Professor Du Bin, director of the INTERNAL Medicine ICU, often asked the question during a room check: 'What else can we do for this patient?' 'When we see the professor of the high-level expert group of the National Health and Care Commission in the room are personally spitting for the patient patting back, in the bed as much as possible to find any possibility of life, as a junior doctor, how can we have the slightest slack? "We can also do something for the patient as Concord Hospital to help The first person in Wuhan, Professor Du Bin, director of the Department of Critical Medicine of internal medicine, as a member of the high-level expert group of the National Health and Health Commission, went to Wuhan on January 18, 2020 to investigate and guide the outbreak, simple return to Beijing reporting work immediately "retrograde" back to Wuhan, a head into the first line of clinical treatment, Chinese New Year's Eve Spring Festival are spent in Wuhan ward It is also a tradition of Concorde that professors visit patients and collect first-hand materials In the intensive care ward of Xinguan, professors seem to have forgotten their age and are struggling to save patients "Our big professor goes to the ward every day, and I admire them, leaving at 8 a.m every morning and coming back at 6 p.m., sometimes not eating a box of lunch a day "Zhang Liyang heartache these experts, wearing protective clothing, sweating, physical discomfort, diarrhea, can not eat, many experts are thin a lot! But it is also the influence of professors to lead by example, so that generations of Concorde thus inherit the association and spirit New crown pneumonia patients in hospital during the family can not visit, serious lysacs are every day and death fighting Given the mood of the families (many even in the hospital), nurses regularly call each patient's family members once a day to tell them about the patient's condition "Because the patient is unaccompanied, we have no right to give up lightly So everyone will struggle to find a way, what else can be done? What else has changed? It also gives young doctors the opportunity to solve problems independently and demonstratetheir their abilities "The action of young doctors often surprises Zhang, such as patients suffering from long-term bed muscle atrophy leading to dislocation of the shoulder joints, orthopaedic expertise is in use, and if patients transferred from the hospital have hemorrhoids, plastic surgeons will come to the bedside to clean up abscess for him "Our professional development is becoming more and more refined because our understanding of the disease is shallow and profound, which is not wrong, but I still advocate that young people should be organic.