The ICU that has been impacted: the more grassroots it is, the more difficult it is to solve, and there is also the difficulty of economic accounts

It was
late at night.
At the entrance of the inpatient building, a middle-aged man hurried upstairs
carrying clothes and quilts in buckets of paint.

At 10 p.
m.
on December 29, Huainan City, Anhui Province, a city with a population of more than 3 million, is the face of the vast majority of cities in China
.
Outside the ICU of Chaoyang Hospital in Huainan, 14 family members are waiting
.
This is a tertiary hospital, and on New Year's Eve, the ICU waiting area is full of people, and there is a folding bed
next to the row of seats.
On the bench in the corner, an old gentleman was drowsed, and two middle-aged women next to him were lying down and sleeping
.

Compared to the noisy emergency room and crowded general ward, the ICU is exceptionally quiet
.
Through a few doors, seriously ill patients are inside, staircases and elevators, and family members are laying outside
.

The waiting family members did not speak, silently looking at their phones or sleeping
.
A family member received a phone call asking about the patient's condition, replied that he was okay and hung up
.
The only quiet in the waiting area is the sound of the wind in the ventilation shaft and the occasional ticking sound in the monitoring room
.

The ICU was full early, most of the patients were in a coma, nurses shuttled back and forth in between, and only from time to time there was a rapid alarm sound from the monitor
.
Suddenly, someone shouted "rescue", and several doctors and nurses rushed to rescue the newly transferred patients
.

Yuan Zhenhua, director of the emergency department and intensive care department of Huainan Chaoyang Hospital, said that such a limit situation has lasted for half a month
.
He told Eight O'Clock that after the social aspect was released, the fever clinic was full at first, and by the end of December, the number of critically ill patients began to increase rapidly, and the ICU, which originally had only 7 or 8 patients, quickly filled 16 beds in one day
.

△The intensive care unit
full of beds in Huainan Chaoyang Hospital.
(Photo by Xi Xiangyu, the same below)

Almost all of them are elderly people with new crown infection that has caused the deterioration of underlying diseases, with an average age of 70 or more, and "basically everyone has pneumonia"
.
There are only two young people, one with brainstem hemorrhage unrelated to the new crown, and the other is a 41-year-old man, who has a high risk factor of obesity, and the oxygen saturation is only about 30% when sent to the emergency room after 6 days of high fever.

”

On December 29, the hospital's emergency department received more than 180 patients and admitted more than 50 people to hospitalization
.
Half of the hospitalized patients met the criteria for intensive care, but beds were not available in the intensive care unit, with only two of the most critically ill patients admitted to the ICU, and the remainder admitted to the cardiac intensive care unit (CCU) and the Respiratory and Critical Care Unit (PCCM).

Song Hong, deputy director of the Department of Cardiology at Huainan Chaoyang Hospital, is also facing the same dilemma
.
The heart center he was in charge of originally had 8 CCU beds, but added 2 beds in the corner
.
The bed spacing was so narrow that the nurse gestured with her hand that she had to turn sideways to get through
.

△ After the cardiac care unit (CCU) added two beds, the nurse could only pass sideways through the bed

Song Hong had just been infected during the New Year's Day and was still coughing violently, and his current difficulties are still the "old three" - medical staff after infection attrition, lack of beds, lack of ventilators
.
Originally, the CCU only had one ventilator, and the hospital urgently allocated 3 for 4 patients with severe lung infection, but there was still a shortage of 1~2 ventilators
.

"Now there are more than 4 'big white lungs', and some 'small white lungs', there is no ventilator for them, so we use masks to take oxygen to solve his chest tightness symptoms
.
" Song Hong said
.
In addition, there is also a shortage of consumables such as oxygen flow meters, protective face shields, and N95 masks, "Everyone is a mask cover for a day, in fact, this is not the right use, but in order to save resources, only this
.
" ”

In Song Hong's CCU, there are basically patients with exacerbations of cardiovascular disease after new crown infection, as well as relatively mild severe patients
transferred from the ICU.

In order to ensure that critically ill patients can be turned, he and ICU director Yuan Zhenhua reached a consensus - try to leave a bed for each other - patients with CCU exacerbation can be transferred to the ICU, and patients in the ICU who do not need ventilators are transferred to the CCU
.

In order to alleviate the dilemma that there is nowhere to turn around for critically ill patients, in some cities, there is another way to move forward at the threshold - relying on graded diagnosis and treatment in the city, intervening and caring for pneumonia patients in advance, and controlling their condition to reduce the impact
on severe resources.

However, with the use of "graded diagnosis and treatment", the situation in large cities is relatively better, and the resources of community health service centers are available quickly
.

Li Li (pseudonym), director of the medical department of a community health service center in Beijing, told Eight Points that patients who come to the community now have blood oxygen saturations below 93% and will be advised to take oxygen
.
The general community will let patients smoke for one hour in the morning and afternoon, for three consecutive days, "these elderly people between the ages of 60 and 70 can generally recover from 90% to no oxygen in three or four days, which can reduce the probability
of developing severe disease to a certain extent.
" ”

There is also a category of patients who have been diagnosed with severe pneumonia in higher-level hospitals, and now there are many infusions in hospitals above the second level, and the elderly and their families are worried that cross-infection will aggravate the condition of the elderly, "They returned to the community after an antibiotic infusion, and we continued infusion treatment while giving him oxygen
.
" ”

On January 4, Shanghai also released the "2022 Shanghai Novel Coronavirus Infection Diagnosis and Treatment Standards and Graded Diagnosis and Treatment Procedures", which proposed that infected people with serious underlying diseases and some severe and critical cases should be referred to district-level hospitals
by community health service centers.

Data show that as of January 3, Shanghai community health service institutions have added 1,711 oxygen positions, 2,562 infusion levels, and 238 fever clinics
.
At the same time, antiviral drugs (small molecule drugs), oxygen meters, oxygen tanks and other materials are preferentially equipped to the community
.

Peking University Medical Ocean Oil Hospital is a second-class hospital in Tianjin, and Su Haihua, director of the Department of Critical Care Medicine, told Eight Points that Tianjin also plays some role
as a medical alliance through "fragmentation and contracting".
As the central hospital of the area, the hospital has four community health service centers on the south bank of the Haihe River to train
the community.
Prior to this, infusion was prohibited in outpatient clinics of first-level hospitals, and now all community health service centers are required to open infusion rooms and oxygen therapy rooms
.

But going beyond the big cities, in a city of the size of Huainan, it is difficult for the tertiary diagnosis and treatment system to function
.

Song Hong, deputy director of the Department of Cardiology at Huainan Chaoyang Hospital, who studied in Shanghai, believes that Shanghai's community hospitals "are equivalent to the level of our county hospitals, and even to the level
of our municipal hospitals.
" ”

Song Hong's hospitalization is relatively heavy, but patients waiting for beds are also difficult to refer to lower-level hospitals
.
According to Song Hong, several county hospitals in Huainan City are also full, "because they are full, and then drive us to be full
.
" ”

"In our city, there may be some doctors in community hospitals who can only see very basic diseases, and even no one is on duty at night, how can patients go?" Song Hong said, "Many community hospitals are not enough technical strength to do complicated, such as not even CT, how to judge 'white lung'?" If you don't even have a monitor, how to rescue a critically ill patient? ”

At present, the peak of severe illness facing Song Hong is still on the rise, and he believes that the peak will continue until around the Spring Festival, not because of a new round of infections caused by people returning to their hometowns, but because children will take the elderly to the hospital
after they return to their hometowns.
"In the past, the old man could not come by himself, the children were not there, and he had no financial money
.
The child has a little money when he comes back from part-time work, and he will be sent to the hospital
to see the elderly.
”

Approaching the Spring Festival, Song Hong's heart is becoming more and more unsteady, and he is worried that the patients admitted to him will become more and more serious
.
After the children returned home, they successively brought sick elderly people into the hospital to see a doctor, and the elderly who were dragged to that time "(sickness) were very serious"
.

The convertible ICU was rushed to start, but lacked equipment and medical care