sharon sanders
Editor-in-Chief & President
Fever clinic in the epidemic storm
December 21, 2022 15:23 The Paper News
185
At 1:00 in the morning, Li Yunhui walked out of the gate of the hot clinic and took off her airtight protective clothing. She felt briefly relieved.
At this time, there are still hundreds of patients queuing up in the consultation room, and some may wait for more than 24 hours. Li Yunhui looked back and knew she couldn't relax.
Li Yunhui is a gynecologist in a tertiary hospital in Guangzhou. Recently, she was transferred to join the fever clinic temporarily set up by the hospital, and she worked "hundred times harder" than usual.
A patient in the early morning fever clinic of Li Yunhui's hospital. Unless otherwise noted, all photos in this article were provided by the interviewees.A patient in the early morning fever clinic of Li Yunhui's hospital. Unless otherwise noted, all photos in this article were provided by the interviewees.
"Priority to fever clinics", under the storm of the epidemic, all regions are reinforcing this sector.
62-year-old Wang Yaqin was originally an obstetrician at Shaanxi People's Hospital. This time she volunteered to sign up to participate in the establishment of a fever clinic in a private specialized hospital. "First try to get through this epidemic," she said.
Waves of patients are pouring into the hospital. It is sometimes difficult to separate patients who are positive and negative for the new crown. Infection among medical staff is almost inevitable.
Zhang Xiujie, a surgeon at a tertiary hospital in Beijing, told us that 90% of his colleagues who were transferred to the fever clinic with him were infected. And Li Yunhui said that once someone is infected, the corresponding department will immediately add manpower to take over, "basically achieve a seamless connection", because the fever clinic cannot stop.
For hospitals and medical care, this is a "big test", and they have paid a lot.
Li Yunhui said that some patients are anxious and panic, and they come to the hospital to seek psychological comfort, and some really can't buy medicines, and they are easy to get angry in a small space. Be more understanding and considerate, special times are not easy.
General hospitals are most likely to be run on. Several interviewed doctors suggested that some patients with mild symptoms can stay at home or obtain doctor's guidance and medication through online consultation.
Protecting hospitals is also our lifeline.
[The following are dictations of several fever clinic doctors]
① Li Yunhui, doctor of a tertiary hospital in Guangzhou
"Priority is given to fever clinics, and colleagues are infected every day"
Our fever clinic was temporarily established in response to the current epidemic situation. Medical staff were drawn from various departments, and each department sent a doctor. I was sent by the gynecology department.
The current epidemic situation is severe, and the leaders of the hospital require that even if the staff in other departments are a little nervous, they must ensure the normal operation of the fever clinic. Because there are more and more positive patients, although we wear protective clothing during the consultation process, we cannot avoid the phenomenon of cross-infection. Colleagues are infected every day. Once infected, the corresponding department immediately sends medical staff to take over. Basically, To achieve seamless docking.
At present, there are 17 posts in the fever clinic, which are divided into adult clinics and pediatric clinics. The pediatric outpatient clinic is composed of pediatricians, and the adult outpatient clinic is composed of physicians, surgeons, gynecologists and other specialists. We work in shifts every day, with nurses in 3 or 4 shifts, and doctors in 4 shifts, from 1 am to 8 am at night. Because it is a shift system, we have three or four doctors on duty at the same time, and each of them works for about 6 hours.
The adult clinic has three clinics during the day and two at night, and the pediatric clinic has one during the day and one at night, that is to say, there are 3+1 clinics during the day and 2+1 clinics at night. Children under the age of 14 who have a fever see the pediatric clinic.
The night when Li Yunhui and his colleagues were on duty.The night when Li Yunhui and his colleagues were on duty.
I roughly estimate that the fever clinic sees 700-800 patients 24 hours a day, and the number of adults is three times that of children. Generally speaking, there are more adults at night, and the three doctors are basically endless. There are basically about 100-200 people on the waiting list, and the waiting time for patients is more than 5 hours.
During the epidemic, doctors worked a hundred times harder than usual, because in addition to receiving negative patients, they also had to take care of positive patients.
It used to be that when entering a hospital to see a doctor, you had to check the itinerary code, health code, etc., but now this process has been cancelled, and all patients with fever have to be triage after antigen detection at the fever clinic.
If it is positive, continue to do diagnosis and treatment in the fever clinic, including prescribing medicine or injection. If the symptoms combined with other specialties are also in the fever clinic, we will contact the on-duty doctors of each specialty.
If the patient has a fever and the antigen test is not positive, he will be diverted to the general outpatient clinic or emergency department according to the condition. An old man with high blood pressure came to the outpatient clinic before. He just had a fever, and the antigen test result was negative, but he did not experience dizziness, or stroke or other emergencies. I suggested that he go to the outpatient department of cardiovascular medicine. , With the negative certificate, he can go to the general outpatient clinic for examination within 48 hours.
If it is a positive patient, if the assessment requires hospitalization, he will be given a nucleic acid test. If the nucleic acid result is also positive, he will be sent to our isolation ward.
The isolation wards are now full and in short supply. Alas, with the sudden increase of so many positive patients, the hospital will not be able to vacate so many wards for a moment, but I believe the hospital will overcome difficulties and properly solve the problem of shortage of wards.
"Coming in line for medical treatment may be seeking a kind of psychological comfort"
Nucleic acid testing has been free for the past three years, but suddenly all staff are no longer required to be tested. I saw that some people panicked and ran to the hospital.
I used to think that only people with weak immunity, such as the elderly or children, would be infected, but in fact, I saw that many young people in their 20s and 30s were also infected.
Symptoms vary from person to person. Some people just have dizziness and headache; some people suddenly develop high fever, runny nose, and cough later; There was a girl who was infected by the virus, she might be a little fragile, she would cry in pain, she was in a bad mood, and she couldn't walk. According to her own description, her whole body was in pain like needle pricks.
Li Yunhui shared his diagnosis and treatment experience on social platforms.Li Yunhui shared his diagnosis and treatment experience on social platforms.
I can feel everyone's anxiety. Every day, someone would go to the front desk of the nurse's station to argue with the nurse, asking why my number hasn't been called yet? There are children and elderly people at home, can we not wait so long? There are also many people who are not feeling well and don't even have a place to sit.
The common people have a kind of fear of the virus, especially those with underlying diseases. They feel even more uneasy in their hearts. They feel that they can only have health protection when they go to the hospital. They come to the hospital for fever clinics and queue up for medical treatment. It may be to seek a kind of psychological comfort.
But in fact, there is a risk of cross-infection when you come to the hospital to queue up for medical treatment. Taking medicine by yourself at home, drinking plenty of warm water, balanced nutrition, and resting more will also achieve a healing effect.
Because I am a gynecologist, the nurses will triage pregnant women to me. That day I saw a 35-week pregnant woman walk in with her belly upright. She had a persistent high fever, dizziness, poor mental state, and no appetite. She couldn't sleep at night, and her lower limbs were sore.
The pregnant woman was very anxious, and her husband was at a loss next to her, so he could only put anti-fever stickers on her and let her drink more water. I suggest that pregnant women should prepare a fetal heart rate monitoring device at home in this case, because if a pregnant woman has a fever, it will cause the fetal heart rate to accelerate, and the fetus cannot stand such a fast fetal heart rate.
When the epidemic is severe, pregnant women can attach a remote fetal movement monitor, transmit data to the monitoring screen of the hospital through a mobile phone, and can also talk to doctors remotely. This method is available to pregnant women whose fetuses are more than 30 weeks old.
It is very inconvenient for pregnant women to move, the outpatient clinic is crowded and noisy, and the risk of cross-infection is high. In response to this situation, we will open up a green channel for pregnant women so that nurses can triage them as soon as possible. But it takes time to call a doctor here, because the doctor on duty in the obstetrics department may be on the operating table, waiting for the doctor to get off the operating table and put on an isolation suit to see the doctor.
Alas, I hope patients will understand and be considerate. To be honest, doctors don't want patients to suffer more.
Li Yunhui is seeing a patient.Li Yunhui is seeing a patient.
During the epidemic, there was a shortage of wards, because positive pregnant women had to go to separate wards. I met a positive pregnant woman whose amniotic fluid broke. After being pushed in on the lathe, I tested the composition of the amniotic fluid, checked the fetal heart rate, and ensured that there was no umbilical cord. Prolapse, no bleeding, and then check her vital signs, blood pressure, heart rate, and blood pressure are all within the normal range. We took the time to check with several people at the same time, and at the same time called the obstetrician doctor, asking him to vacate a room quickly and temporarily move the patients in this room to other wards for crowding, so as to ensure the safety of the mother and child.
It is not easy to buy medicines outside now. I see that the homeowners in our community are saying that they cannot get medicines. Not only are the resources of the pharmacies tight, but the hospitals are also short of medicines. We are often open and open, and one kind of medicine cannot be prescribed, so we have to keep changing medicines with similar efficacy.
Our hospital can basically guarantee the normal supply of medicines, but there are some medicines that pregnant women need, which are in short supply. For example, the antipyretics that pregnant women can use are the only ones. When there is no medicine, we can only prescribe some antipyretics for children. will be safer. Our hospital attaches great importance to the shortage of medicines for pregnant women and is trying to solve it.
"Designated hospitals are also overcrowded, and mild cases can be consulted online"
There are three main types of diagnosis and treatment in our fever clinic: for patients with mild symptoms, we mainly prescribe oral medicine, and instruct them to rest at home and observe at home; If the symptoms improve, let him go home; there is another kind of patients who need to be hospitalized, they will be sent to designated hospitals, and some serious ones will need to be escorted by a doctor to transfer.
Every day, we have some patients with serious conditions, such as pneumonia, whose vital signs and blood oxygen are not very good. If they do not inhale oxygen, it is very difficult to breathe, and the high fever persists. Some patients have undergone heart valve surgery. , Let go of the stent, chest pain, some patients have gastrointestinal bleeding, or patients with tumors, after radiotherapy and chemotherapy, their health is not good, and at the same time they become positive. After evaluation, we will receive the designated hospital to go to the hospital. .
The designated hospitals are also overcrowded, so patients will be admitted and treated according to the severity of the condition, with priority given to the critically ill. For example, if a patient with asthma has an attack, it is very dangerous, because the bronchospasm makes it hard to breathe. So I suggest that you must understand the medical history of your family members, and prepare some first aid medicines, blood pressure lowering medicines, Suxiao Jiuxin Pills, bronchodilator medicines, etc.
The most important thing for doctors in our fever clinics is to recognize the symptoms of patients and know how to triage them. For patients who need first aid, they must be treated on the spot. For example, if a patient suddenly suffers from a myocardial infarction and falls to the ground, he needs to immediately drop everything and race against time to do cardiopulmonary resuscitation. There are also patients with pneumonia or chemotherapy. Although they are not so anxious, their condition needs to be paid attention to, and they must actively contact all doctors for consultation.
Now there are not so many venues for diversion. The positive and negative are lined up in a line, mixed in the same hall, and there is not even a place to sit.
I will repeatedly tell people who come to the hospital to take good personal protection. It is best to wear N95 masks, but N95 masks are in short supply, so ordinary medical masks are also acceptable. Wear the mask before coming to the hospital. Yes, you can also wear a hat and gloves before going out, and carry a bottle of alcohol spray on your body to disinfect at any time.
It is recommended that patients with mild symptoms can see a doctor on the Internet, and prescribe medicines online. If the doctor thinks they need to go to the hospital, they will go to the hospital for treatment. I know that Guangdong Provincial People's Hospital has opened online consultation, and our hospital is still under development.
"I work non-stop and can watch one is the other"
My parents are far away in Hunan, and they are both infected with the new crown virus, but I don't even have time to make a phone call, let alone go home to visit my parents.
Although my parents were both infected, they were most worried about my health.
I'm also worried, so I can only take precautions. Every day when I go to the outpatient clinic, I first put on protective clothing, a mask and an isolation protective mask, and check the airtightness of the mask. If it is tightly tied, breathing will be difficult and stuffy. We can't go to the toilet for 6 hours, because it is very troublesome to put on and take off. A colleague has a period and can only use baby diapers. Before we go to work, we don't eat too much or drink too much water.
When I wear glasses, when the hot air hits the cool lenses, it will fog up and my vision will be blurred. In order to prevent fogging, you can only make the surrounding air very cold and turn on a fan next to it. It was very cold in the early hours of the morning, but the air conditioner could not be turned on, because we had to turn on the air purifier, and the room doors had to be opened to circulate. We could only put a little sun by the side, but it was not good if it was too warm, because the glasses would fog up.
We cannot limit the number of fever clinics. Even at night, patients have been waiting in line. I often meet patients who have been waiting for more than 24 hours.
There are many people every day, the space is small, the patients are anxious, and they keep urging. I keep working and want to go as fast as possible. Some anxious patients will quarrel with the nurses. We have to calm the patients’ emotions and explain the work. Feeling overwhelmed at times. One of my colleagues fainted directly, was carried out, took off the mask, and asked her to breathe.
After 6 hours, my face was also covered with red marks by the mask.
After work, I will take off the isolation suit, wash my hands, take a shower, walk outside the hospital, leave the virus area, and take a big breath of fresh air. There will be a sense of accomplishment at that moment, and then I look back and find that there are still hundreds of people queuing up, and I feel that there is nothing I can do in an instant.
The list of patients in the waiting area is getting more and more numerous. Once the pace is slowed down, the patients will have to wait for an extra hour, or a few more hours. I know in my heart that patients can't finish watching, but it's good to see one.
②Wang Yaqin, doctor of a specialized hospital in Shaanxi
"I am 62 years old, and I voluntarily applied to the fever clinic"
I was originally an obstetrician at Shaanxi Provincial People's Hospital. On December 1, I was transferred to the fever clinic of our local private specialized hospital. Together with 10 other colleagues, I helped these mothers and children.
If there are too many patients with fever, general hospitals and tertiary hospitals will not be able to see them. Therefore, in order to mobilize all medical institutions to be able to treat patients, we in Xi'an City held several meetings in a row, asking hospitals with medical qualifications to develop popular clinics.
Our fever clinic is not only for pregnant women, but also for other patients in the society. The volume was very large. From 5:00 pm to 10:00 pm the day before yesterday, more than 40 patients came.
On the first day of setting up the fever clinic, we did training. Yesterday at 12:00 noon, we conducted training again, and another training session at 3:00 p.m. From 4:00 to 5:00, I had a consultation and discussion with colleagues from the Department of Internal Medicine, Department of Infectious Diseases, and the Department of Medical Education for a positive pregnant woman with fever.
Wang Yaqin and colleagues discuss the patient's condition.Wang Yaqin and colleagues discuss the patient's condition.
For different patients, pregnant women, children, ordinary people, and the elderly, we have a plan to deal with them one by one. If the patient is seriously ill, we will refer to the general hospital and treatment center step by step. Some treatment centers have been built in Xi'an, and last night the Health and Medical Commission was still training hospitals at all levels to come up with emergency plans.
In fact, in 2018, I did a project on the referral of pregnant women on the three-level network cloud platform of provinces, cities and counties. I studied the circumstances under which patients were referred. There are five colors of referrals, divided into green, yellow, orange, red, and purple. Purple means infection. Disease, the new crown is purple. Patients or pregnant women in obstetrics and gynecology are not only pregnant, but also have other symptoms, including high blood pressure, heart disease, AIDS, and new crowns. Therefore, as an obstetrician and gynecologist, you can’t just deliver babies, do caesarean sections, and cut a uterus. .
At present, general hospitals have limited medical resources and are prone to run out. Therefore, we first try our best to treat mild and ordinary patients, and reduce the pressure on general hospitals and intensive care units. We cannot push all these mild patients to the hospital, otherwise they will be under great pressure.
Many of the patients we see are pregnant women and children. The fever clinic works in three shifts 24 hours a day, and doctors work in 8-hour shifts. There must be no one here, and some patients need emergency treatment.
Wang Yaqin is seeing patients.Wang Yaqin is seeing patients.
Recently, our colleagues also have positive. There are about 500 employees in the hospital, and colleagues with symptoms account for about 1/10 or 1/12.
Every day at noon, we would drink the decoction boiled in the Chinese pharmacy, put it in a large bucket, drink it twice in the morning and afternoon, then wear masks, wash our hands frequently, and avoid gatherings. Before setting up the fever clinic, I told you the prevention methods. One is to strengthen nutrition, vitamins, and protein. The other is to eat more fruits, drink water, and get enough sleep.
If our medical staff have symptoms, we will treat them directly and rest at home. Try not to be infected, or less infected, late infection.
If we work in the outpatient clinic, we will have to see forty or fifty patients in half a day, among which there are more mild patients. Not all of them are patients infected with the new crown, but there are also patients with the common cold.
In the past, we had designated hospitals, closed areas, isolation areas, and buffer zones; now, according to national documents, no matter if it is a specialized hospital or a general hospital, as long as it is a medical institution, it must receive positive patients.
Our place is divided into regions. If you have a fever, you will be tested for antigens. The tenth floor receives patients with new crown and fever, and the ninth floor is for ordinary patients. The hospital has regulations not to let patients with new crowns infect ordinary patients. Patients with new crowns are all in single rooms.
Many medicines are in short supply now. We prepared some medicines that are in short supply yesterday. For some serious patients, if they suffer from dehydration, we will use some hormonal medicines, which can also relieve symptoms. Some patients must take a certain kind of medicine. If the medicine is not available, it can be replaced by the same kind of medicine.
In the past ten days of working in the fever clinic, I have also encountered some troublesome situations. A few days ago, a patient with a fever insisted on buying a certain kind of medicine. He didn't study medicine, but he just saw that kind of medicine was very popular on the Internet, so he wanted it. We had this medicine two days ago, but when he came, it was gone.
He was not very satisfied. Later, we brought in internal medicine experts and a fever clinic to explain to him that other medicines can also be used. In fact, if you don't have a fever, or just for prevention, there is no need to use more medicine, because taking medicine is three-point poisonous. Symptoms must also be under the guidance of a doctor, according to scientific methods, which medicine should be used.
I am 62 years old, and I voluntarily applied to work in the fever clinic here. I just want to work hard to get through this epidemic first.
③ Zhang Xiujie (pseudonym), doctor of a tertiary hospital in Beijing
"Fever outpatients are now slowly decreasing, and medicines are still in short supply"
I am a surgeon. Two weeks ago, according to the arrangement of the hospital, I was temporarily transferred to the fever clinic for support.
There were fourteen or fifteen colleagues transferred with me, and we all came from various departments. Before starting work, the hospital provided simple protective training, such as how to put on and take off gowns, hats, masks, face screens, etc.
In the fever clinic, we work on a shift system. We have one shift for three days, and one shift lasts 6 hours. There are more than 30 doctors in total. Doctors must be available 24 hours a day. I have been on shifts from 2:00 am to 8:00 am several times. There are relatively few patients in this time period.
There is no triage in our fever clinics.
Both negative and positive patients are treated together, because 80% of the patients are positive. I see up to 30 patients a day, and there are people of all ages. Their main symptoms are fever, sore throat, chest tightness, diarrhea, and abdominal pain. Patients with new crown fever are different from ordinary fever patients in that they have body pain.
For example, a few days ago, an 80-year-old man had a fever of 39 degrees and his whole body hurt. He came alone, and I prescribed antipyretic and analgesic drugs for him. Although he had diabetes and high blood pressure, his physical condition and mood were quite normal at the time, so he left after I prescribed the drugs for him.
There is also an old man in his 70s and 80s, sitting in a wheelchair, and his family pushed him to see a doctor. At that time, he had a fever of 39 degrees. He was prescribed fever-reducing medicine. There is also a critically ill patient that I am more impressed with. He is a leukemia patient. He is only in his 30s. In the fever clinic, we treat him symptomatically. Further treatment for his leukemia.
I was not in the fever clinic before, so I don't know how many patients there are every day. When it was first released, the fever clinics saw more than 200 patients a day, but now it has gradually decreased to about 150 patients a day.
Some of these positive patients I see experience fear or anxiety. Now there is a problem that there is a shortage of medicines, such as Tylenol, which cannot be bought in many places.
After coming to the fever clinic for support, my own department sometimes lacks manpower, and there are no doctors to perform some operations. I am also more worried about the patients in my own department. There is also a question of cost. For example, the cost of protective clothing worn by patients for medical treatment is borne by the hospital. Should the cost of these epidemic prevention tasks be borne by the top three hospitals?
Many people have been infected, but I have not yet been infected.
At the beginning, I will pay special attention to protection and disinfect frequently. Later, it was the basic protection. When going to work, I put on protective clothing, protective masks, masks and gloves. I was not allowed to go to the toilet for 6 hours during the working period, and I could only hold back until the moment I got off work.
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December 21, 2022 15:23 The Paper News
185
At 1:00 in the morning, Li Yunhui walked out of the gate of the hot clinic and took off her airtight protective clothing. She felt briefly relieved.
At this time, there are still hundreds of patients queuing up in the consultation room, and some may wait for more than 24 hours. Li Yunhui looked back and knew she couldn't relax.
Li Yunhui is a gynecologist in a tertiary hospital in Guangzhou. Recently, she was transferred to join the fever clinic temporarily set up by the hospital, and she worked "hundred times harder" than usual.
A patient in the early morning fever clinic of Li Yunhui's hospital. Unless otherwise noted, all photos in this article were provided by the interviewees.A patient in the early morning fever clinic of Li Yunhui's hospital. Unless otherwise noted, all photos in this article were provided by the interviewees.
"Priority to fever clinics", under the storm of the epidemic, all regions are reinforcing this sector.
62-year-old Wang Yaqin was originally an obstetrician at Shaanxi People's Hospital. This time she volunteered to sign up to participate in the establishment of a fever clinic in a private specialized hospital. "First try to get through this epidemic," she said.
Waves of patients are pouring into the hospital. It is sometimes difficult to separate patients who are positive and negative for the new crown. Infection among medical staff is almost inevitable.
Zhang Xiujie, a surgeon at a tertiary hospital in Beijing, told us that 90% of his colleagues who were transferred to the fever clinic with him were infected. And Li Yunhui said that once someone is infected, the corresponding department will immediately add manpower to take over, "basically achieve a seamless connection", because the fever clinic cannot stop.
For hospitals and medical care, this is a "big test", and they have paid a lot.
Li Yunhui said that some patients are anxious and panic, and they come to the hospital to seek psychological comfort, and some really can't buy medicines, and they are easy to get angry in a small space. Be more understanding and considerate, special times are not easy.
General hospitals are most likely to be run on. Several interviewed doctors suggested that some patients with mild symptoms can stay at home or obtain doctor's guidance and medication through online consultation.
Protecting hospitals is also our lifeline.
[The following are dictations of several fever clinic doctors]
① Li Yunhui, doctor of a tertiary hospital in Guangzhou
"Priority is given to fever clinics, and colleagues are infected every day"
Our fever clinic was temporarily established in response to the current epidemic situation. Medical staff were drawn from various departments, and each department sent a doctor. I was sent by the gynecology department.
The current epidemic situation is severe, and the leaders of the hospital require that even if the staff in other departments are a little nervous, they must ensure the normal operation of the fever clinic. Because there are more and more positive patients, although we wear protective clothing during the consultation process, we cannot avoid the phenomenon of cross-infection. Colleagues are infected every day. Once infected, the corresponding department immediately sends medical staff to take over. Basically, To achieve seamless docking.
At present, there are 17 posts in the fever clinic, which are divided into adult clinics and pediatric clinics. The pediatric outpatient clinic is composed of pediatricians, and the adult outpatient clinic is composed of physicians, surgeons, gynecologists and other specialists. We work in shifts every day, with nurses in 3 or 4 shifts, and doctors in 4 shifts, from 1 am to 8 am at night. Because it is a shift system, we have three or four doctors on duty at the same time, and each of them works for about 6 hours.
The adult clinic has three clinics during the day and two at night, and the pediatric clinic has one during the day and one at night, that is to say, there are 3+1 clinics during the day and 2+1 clinics at night. Children under the age of 14 who have a fever see the pediatric clinic.
The night when Li Yunhui and his colleagues were on duty.The night when Li Yunhui and his colleagues were on duty.
I roughly estimate that the fever clinic sees 700-800 patients 24 hours a day, and the number of adults is three times that of children. Generally speaking, there are more adults at night, and the three doctors are basically endless. There are basically about 100-200 people on the waiting list, and the waiting time for patients is more than 5 hours.
During the epidemic, doctors worked a hundred times harder than usual, because in addition to receiving negative patients, they also had to take care of positive patients.
It used to be that when entering a hospital to see a doctor, you had to check the itinerary code, health code, etc., but now this process has been cancelled, and all patients with fever have to be triage after antigen detection at the fever clinic.
If it is positive, continue to do diagnosis and treatment in the fever clinic, including prescribing medicine or injection. If the symptoms combined with other specialties are also in the fever clinic, we will contact the on-duty doctors of each specialty.
If the patient has a fever and the antigen test is not positive, he will be diverted to the general outpatient clinic or emergency department according to the condition. An old man with high blood pressure came to the outpatient clinic before. He just had a fever, and the antigen test result was negative, but he did not experience dizziness, or stroke or other emergencies. I suggested that he go to the outpatient department of cardiovascular medicine. , With the negative certificate, he can go to the general outpatient clinic for examination within 48 hours.
If it is a positive patient, if the assessment requires hospitalization, he will be given a nucleic acid test. If the nucleic acid result is also positive, he will be sent to our isolation ward.
The isolation wards are now full and in short supply. Alas, with the sudden increase of so many positive patients, the hospital will not be able to vacate so many wards for a moment, but I believe the hospital will overcome difficulties and properly solve the problem of shortage of wards.
"Coming in line for medical treatment may be seeking a kind of psychological comfort"
Nucleic acid testing has been free for the past three years, but suddenly all staff are no longer required to be tested. I saw that some people panicked and ran to the hospital.
I used to think that only people with weak immunity, such as the elderly or children, would be infected, but in fact, I saw that many young people in their 20s and 30s were also infected.
Symptoms vary from person to person. Some people just have dizziness and headache; some people suddenly develop high fever, runny nose, and cough later; There was a girl who was infected by the virus, she might be a little fragile, she would cry in pain, she was in a bad mood, and she couldn't walk. According to her own description, her whole body was in pain like needle pricks.
Li Yunhui shared his diagnosis and treatment experience on social platforms.Li Yunhui shared his diagnosis and treatment experience on social platforms.
I can feel everyone's anxiety. Every day, someone would go to the front desk of the nurse's station to argue with the nurse, asking why my number hasn't been called yet? There are children and elderly people at home, can we not wait so long? There are also many people who are not feeling well and don't even have a place to sit.
The common people have a kind of fear of the virus, especially those with underlying diseases. They feel even more uneasy in their hearts. They feel that they can only have health protection when they go to the hospital. They come to the hospital for fever clinics and queue up for medical treatment. It may be to seek a kind of psychological comfort.
But in fact, there is a risk of cross-infection when you come to the hospital to queue up for medical treatment. Taking medicine by yourself at home, drinking plenty of warm water, balanced nutrition, and resting more will also achieve a healing effect.
Because I am a gynecologist, the nurses will triage pregnant women to me. That day I saw a 35-week pregnant woman walk in with her belly upright. She had a persistent high fever, dizziness, poor mental state, and no appetite. She couldn't sleep at night, and her lower limbs were sore.
The pregnant woman was very anxious, and her husband was at a loss next to her, so he could only put anti-fever stickers on her and let her drink more water. I suggest that pregnant women should prepare a fetal heart rate monitoring device at home in this case, because if a pregnant woman has a fever, it will cause the fetal heart rate to accelerate, and the fetus cannot stand such a fast fetal heart rate.
When the epidemic is severe, pregnant women can attach a remote fetal movement monitor, transmit data to the monitoring screen of the hospital through a mobile phone, and can also talk to doctors remotely. This method is available to pregnant women whose fetuses are more than 30 weeks old.
It is very inconvenient for pregnant women to move, the outpatient clinic is crowded and noisy, and the risk of cross-infection is high. In response to this situation, we will open up a green channel for pregnant women so that nurses can triage them as soon as possible. But it takes time to call a doctor here, because the doctor on duty in the obstetrics department may be on the operating table, waiting for the doctor to get off the operating table and put on an isolation suit to see the doctor.
Alas, I hope patients will understand and be considerate. To be honest, doctors don't want patients to suffer more.
Li Yunhui is seeing a patient.Li Yunhui is seeing a patient.
During the epidemic, there was a shortage of wards, because positive pregnant women had to go to separate wards. I met a positive pregnant woman whose amniotic fluid broke. After being pushed in on the lathe, I tested the composition of the amniotic fluid, checked the fetal heart rate, and ensured that there was no umbilical cord. Prolapse, no bleeding, and then check her vital signs, blood pressure, heart rate, and blood pressure are all within the normal range. We took the time to check with several people at the same time, and at the same time called the obstetrician doctor, asking him to vacate a room quickly and temporarily move the patients in this room to other wards for crowding, so as to ensure the safety of the mother and child.
It is not easy to buy medicines outside now. I see that the homeowners in our community are saying that they cannot get medicines. Not only are the resources of the pharmacies tight, but the hospitals are also short of medicines. We are often open and open, and one kind of medicine cannot be prescribed, so we have to keep changing medicines with similar efficacy.
Our hospital can basically guarantee the normal supply of medicines, but there are some medicines that pregnant women need, which are in short supply. For example, the antipyretics that pregnant women can use are the only ones. When there is no medicine, we can only prescribe some antipyretics for children. will be safer. Our hospital attaches great importance to the shortage of medicines for pregnant women and is trying to solve it.
"Designated hospitals are also overcrowded, and mild cases can be consulted online"
There are three main types of diagnosis and treatment in our fever clinic: for patients with mild symptoms, we mainly prescribe oral medicine, and instruct them to rest at home and observe at home; If the symptoms improve, let him go home; there is another kind of patients who need to be hospitalized, they will be sent to designated hospitals, and some serious ones will need to be escorted by a doctor to transfer.
Every day, we have some patients with serious conditions, such as pneumonia, whose vital signs and blood oxygen are not very good. If they do not inhale oxygen, it is very difficult to breathe, and the high fever persists. Some patients have undergone heart valve surgery. , Let go of the stent, chest pain, some patients have gastrointestinal bleeding, or patients with tumors, after radiotherapy and chemotherapy, their health is not good, and at the same time they become positive. After evaluation, we will receive the designated hospital to go to the hospital. .
The designated hospitals are also overcrowded, so patients will be admitted and treated according to the severity of the condition, with priority given to the critically ill. For example, if a patient with asthma has an attack, it is very dangerous, because the bronchospasm makes it hard to breathe. So I suggest that you must understand the medical history of your family members, and prepare some first aid medicines, blood pressure lowering medicines, Suxiao Jiuxin Pills, bronchodilator medicines, etc.
The most important thing for doctors in our fever clinics is to recognize the symptoms of patients and know how to triage them. For patients who need first aid, they must be treated on the spot. For example, if a patient suddenly suffers from a myocardial infarction and falls to the ground, he needs to immediately drop everything and race against time to do cardiopulmonary resuscitation. There are also patients with pneumonia or chemotherapy. Although they are not so anxious, their condition needs to be paid attention to, and they must actively contact all doctors for consultation.
Now there are not so many venues for diversion. The positive and negative are lined up in a line, mixed in the same hall, and there is not even a place to sit.
I will repeatedly tell people who come to the hospital to take good personal protection. It is best to wear N95 masks, but N95 masks are in short supply, so ordinary medical masks are also acceptable. Wear the mask before coming to the hospital. Yes, you can also wear a hat and gloves before going out, and carry a bottle of alcohol spray on your body to disinfect at any time.
It is recommended that patients with mild symptoms can see a doctor on the Internet, and prescribe medicines online. If the doctor thinks they need to go to the hospital, they will go to the hospital for treatment. I know that Guangdong Provincial People's Hospital has opened online consultation, and our hospital is still under development.
"I work non-stop and can watch one is the other"
My parents are far away in Hunan, and they are both infected with the new crown virus, but I don't even have time to make a phone call, let alone go home to visit my parents.
Although my parents were both infected, they were most worried about my health.
I'm also worried, so I can only take precautions. Every day when I go to the outpatient clinic, I first put on protective clothing, a mask and an isolation protective mask, and check the airtightness of the mask. If it is tightly tied, breathing will be difficult and stuffy. We can't go to the toilet for 6 hours, because it is very troublesome to put on and take off. A colleague has a period and can only use baby diapers. Before we go to work, we don't eat too much or drink too much water.
When I wear glasses, when the hot air hits the cool lenses, it will fog up and my vision will be blurred. In order to prevent fogging, you can only make the surrounding air very cold and turn on a fan next to it. It was very cold in the early hours of the morning, but the air conditioner could not be turned on, because we had to turn on the air purifier, and the room doors had to be opened to circulate. We could only put a little sun by the side, but it was not good if it was too warm, because the glasses would fog up.
We cannot limit the number of fever clinics. Even at night, patients have been waiting in line. I often meet patients who have been waiting for more than 24 hours.
There are many people every day, the space is small, the patients are anxious, and they keep urging. I keep working and want to go as fast as possible. Some anxious patients will quarrel with the nurses. We have to calm the patients’ emotions and explain the work. Feeling overwhelmed at times. One of my colleagues fainted directly, was carried out, took off the mask, and asked her to breathe.
After 6 hours, my face was also covered with red marks by the mask.
After work, I will take off the isolation suit, wash my hands, take a shower, walk outside the hospital, leave the virus area, and take a big breath of fresh air. There will be a sense of accomplishment at that moment, and then I look back and find that there are still hundreds of people queuing up, and I feel that there is nothing I can do in an instant.
The list of patients in the waiting area is getting more and more numerous. Once the pace is slowed down, the patients will have to wait for an extra hour, or a few more hours. I know in my heart that patients can't finish watching, but it's good to see one.
②Wang Yaqin, doctor of a specialized hospital in Shaanxi
"I am 62 years old, and I voluntarily applied to the fever clinic"
I was originally an obstetrician at Shaanxi Provincial People's Hospital. On December 1, I was transferred to the fever clinic of our local private specialized hospital. Together with 10 other colleagues, I helped these mothers and children.
If there are too many patients with fever, general hospitals and tertiary hospitals will not be able to see them. Therefore, in order to mobilize all medical institutions to be able to treat patients, we in Xi'an City held several meetings in a row, asking hospitals with medical qualifications to develop popular clinics.
Our fever clinic is not only for pregnant women, but also for other patients in the society. The volume was very large. From 5:00 pm to 10:00 pm the day before yesterday, more than 40 patients came.
On the first day of setting up the fever clinic, we did training. Yesterday at 12:00 noon, we conducted training again, and another training session at 3:00 p.m. From 4:00 to 5:00, I had a consultation and discussion with colleagues from the Department of Internal Medicine, Department of Infectious Diseases, and the Department of Medical Education for a positive pregnant woman with fever.
Wang Yaqin and colleagues discuss the patient's condition.Wang Yaqin and colleagues discuss the patient's condition.
For different patients, pregnant women, children, ordinary people, and the elderly, we have a plan to deal with them one by one. If the patient is seriously ill, we will refer to the general hospital and treatment center step by step. Some treatment centers have been built in Xi'an, and last night the Health and Medical Commission was still training hospitals at all levels to come up with emergency plans.
In fact, in 2018, I did a project on the referral of pregnant women on the three-level network cloud platform of provinces, cities and counties. I studied the circumstances under which patients were referred. There are five colors of referrals, divided into green, yellow, orange, red, and purple. Purple means infection. Disease, the new crown is purple. Patients or pregnant women in obstetrics and gynecology are not only pregnant, but also have other symptoms, including high blood pressure, heart disease, AIDS, and new crowns. Therefore, as an obstetrician and gynecologist, you can’t just deliver babies, do caesarean sections, and cut a uterus. .
At present, general hospitals have limited medical resources and are prone to run out. Therefore, we first try our best to treat mild and ordinary patients, and reduce the pressure on general hospitals and intensive care units. We cannot push all these mild patients to the hospital, otherwise they will be under great pressure.
Many of the patients we see are pregnant women and children. The fever clinic works in three shifts 24 hours a day, and doctors work in 8-hour shifts. There must be no one here, and some patients need emergency treatment.
Wang Yaqin is seeing patients.Wang Yaqin is seeing patients.
Recently, our colleagues also have positive. There are about 500 employees in the hospital, and colleagues with symptoms account for about 1/10 or 1/12.
Every day at noon, we would drink the decoction boiled in the Chinese pharmacy, put it in a large bucket, drink it twice in the morning and afternoon, then wear masks, wash our hands frequently, and avoid gatherings. Before setting up the fever clinic, I told you the prevention methods. One is to strengthen nutrition, vitamins, and protein. The other is to eat more fruits, drink water, and get enough sleep.
If our medical staff have symptoms, we will treat them directly and rest at home. Try not to be infected, or less infected, late infection.
If we work in the outpatient clinic, we will have to see forty or fifty patients in half a day, among which there are more mild patients. Not all of them are patients infected with the new crown, but there are also patients with the common cold.
In the past, we had designated hospitals, closed areas, isolation areas, and buffer zones; now, according to national documents, no matter if it is a specialized hospital or a general hospital, as long as it is a medical institution, it must receive positive patients.
Our place is divided into regions. If you have a fever, you will be tested for antigens. The tenth floor receives patients with new crown and fever, and the ninth floor is for ordinary patients. The hospital has regulations not to let patients with new crowns infect ordinary patients. Patients with new crowns are all in single rooms.
Many medicines are in short supply now. We prepared some medicines that are in short supply yesterday. For some serious patients, if they suffer from dehydration, we will use some hormonal medicines, which can also relieve symptoms. Some patients must take a certain kind of medicine. If the medicine is not available, it can be replaced by the same kind of medicine.
In the past ten days of working in the fever clinic, I have also encountered some troublesome situations. A few days ago, a patient with a fever insisted on buying a certain kind of medicine. He didn't study medicine, but he just saw that kind of medicine was very popular on the Internet, so he wanted it. We had this medicine two days ago, but when he came, it was gone.
He was not very satisfied. Later, we brought in internal medicine experts and a fever clinic to explain to him that other medicines can also be used. In fact, if you don't have a fever, or just for prevention, there is no need to use more medicine, because taking medicine is three-point poisonous. Symptoms must also be under the guidance of a doctor, according to scientific methods, which medicine should be used.
I am 62 years old, and I voluntarily applied to work in the fever clinic here. I just want to work hard to get through this epidemic first.
③ Zhang Xiujie (pseudonym), doctor of a tertiary hospital in Beijing
"Fever outpatients are now slowly decreasing, and medicines are still in short supply"
I am a surgeon. Two weeks ago, according to the arrangement of the hospital, I was temporarily transferred to the fever clinic for support.
There were fourteen or fifteen colleagues transferred with me, and we all came from various departments. Before starting work, the hospital provided simple protective training, such as how to put on and take off gowns, hats, masks, face screens, etc.
In the fever clinic, we work on a shift system. We have one shift for three days, and one shift lasts 6 hours. There are more than 30 doctors in total. Doctors must be available 24 hours a day. I have been on shifts from 2:00 am to 8:00 am several times. There are relatively few patients in this time period.
There is no triage in our fever clinics.
Both negative and positive patients are treated together, because 80% of the patients are positive. I see up to 30 patients a day, and there are people of all ages. Their main symptoms are fever, sore throat, chest tightness, diarrhea, and abdominal pain. Patients with new crown fever are different from ordinary fever patients in that they have body pain.
For example, a few days ago, an 80-year-old man had a fever of 39 degrees and his whole body hurt. He came alone, and I prescribed antipyretic and analgesic drugs for him. Although he had diabetes and high blood pressure, his physical condition and mood were quite normal at the time, so he left after I prescribed the drugs for him.
There is also an old man in his 70s and 80s, sitting in a wheelchair, and his family pushed him to see a doctor. At that time, he had a fever of 39 degrees. He was prescribed fever-reducing medicine. There is also a critically ill patient that I am more impressed with. He is a leukemia patient. He is only in his 30s. In the fever clinic, we treat him symptomatically. Further treatment for his leukemia.
I was not in the fever clinic before, so I don't know how many patients there are every day. When it was first released, the fever clinics saw more than 200 patients a day, but now it has gradually decreased to about 150 patients a day.
Some of these positive patients I see experience fear or anxiety. Now there is a problem that there is a shortage of medicines, such as Tylenol, which cannot be bought in many places.
After coming to the fever clinic for support, my own department sometimes lacks manpower, and there are no doctors to perform some operations. I am also more worried about the patients in my own department. There is also a question of cost. For example, the cost of protective clothing worn by patients for medical treatment is borne by the hospital. Should the cost of these epidemic prevention tasks be borne by the top three hospitals?
Many people have been infected, but I have not yet been infected.
At the beginning, I will pay special attention to protection and disinfect frequently. Later, it was the basic protection. When going to work, I put on protective clothing, protective masks, masks and gloves. I was not allowed to go to the toilet for 6 hours during the working period, and I could only hold back until the moment I got off work.
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