Streptomycin is a commonly used first-line antibiotic in clinical practice. As an aminoglycoside antibiotic, it is cheap to use and has good anti-infection effect. The main reason why Sun Lien decided to use streptomycin and ciprofloxacin in combination was based on the plague diagnosis and treatment plan issued by the Health Commission in 2011.

As a guiding document for plague treatment in health institutions, the plan specifies the diagnosis method of the disease, the recommended dosage and type of medication, disinfection and care, etc. Within the allowable range, the maximum dose of streptomycin intramuscular injection, and the combination of ciprofloxacin is actually a very tough anti-infection method. However, Sun Lien was not sure whether this dose was enough—the symptoms of Tang Xingde and Hou Huiying were too serious.

"The results of blood routine, blood qi, liver function and renal function have come out. The number of platelets in three patients has decreased. Tang Xingde has acute liver injury and acute renal failure, his wife has acute renal failure and metabolic acidosis." Xu Yourong shouted at Sun Lien. She saw the examination data in front of the computer. The paper checklist is still printing.

"Give Zhou Ce the data on kidney function and ask him your opinion." Acute renal failure is mild or severe. Not every acute renal failure needs to be dealt with immediately. There are always priorities. In the case of life-threatening conditions, it is the key to deal with the patient's respiratory and circulation system problems first. Without kidneys, patients may die within a few days. According to estimates that all three of them were infected with plague two days ago, it is about one day before the plague Yersinia plague took their lives. But without a respiratory and circulation system, no one can live for five minutes.

First deal with the respiratory and circulatory problems, then turn your attention to the plague. Finally, deal with acute kidney injury and liver injury. This is the correct treatment plan to protect this family of three with the greatest chance of survival.

Help your life first, then treat the disease.

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"Streptomycin cannot be used, the patient has acute renal failure." Zhou Ce called the emergency room directly. He also knew that Sun Lien had received three highly suspected plague patients. According to the plague diagnosis and treatment plan of the Health Commission, streptomycin is the recommended therapeutic drug. However, this patient who has shown impaired renal function needs to avoid using streptomycin as much as possible - streptomycin does not metabolize directly or react in the human body, and mainly relies on the excretion of the kidneys. If the patient has renal function damage, it is also T1/2 metabolism, and the original two-hour metabolic degree would be extended to more than 10 hours. However, the human body is in a high-concentration streptomycin environment for a long time, which may cause serious toxic side effects. After Zhou Ce made this happen, he immediately called the rescue room. He estimated that Sun Lien was not particularly sensitive to this point. "Cefopiptamine can be used to treat it."

Cefopiptamine is a third-generation cephalosporin antibiotic. Although there is still relatively little information on using third-generation cephalosporin to treat plague, many drug sensitivity experiments have proved that Yersinia plague is extremely sensitive to third-generation cephalosporin. Its sensitivity is even higher than that of traditional anti-plague antibiotics such as streptomycin and gentamicin. More importantly, after intravenous injection of cephalosporin, the blood concentration increases faster than intramuscular streptomycin, and it is mainly excreted by bile and can still maintain good metabolism under conditions of renal insufficiency.

"Cefiperidine, right? I know. Do you still need to continue to use ciprofloxacin?" Sun Lien trusted Zhou Ce's suggestions very much. After all, he has much more work experience than himself. Especially for the medication experience under renal insufficiency, twenty Sun Lien tied together, but they are not as experienced as Zhou Ce's one-head last year.

"Pneumoplague is a severe case, so you must use the drug in combination. Fluoroquinolones are fine, and ciprofloxacin is fine. Even if there are minors in the patient, they can't care about it. It's better not to grow taller than to die."

Tang Wen is already an adult, so he is not afraid of the cartilage toxicity of ciprofloxacin. Sun Lien adjusted the medication and breathed a little relieved after watching the nurses injected all the three of them with medication.

The next work mainly depends on the hospital infection department and infectious disease department. Of course, because it is pneumoplague, the respiratory department also needs to support doctors to participate in the treatment work. The doctors who support them must be selected according to the tacit rules within the hospital.

Party members, married, have children, and are not only born as the first batch of lottery draws. According to the level, everyone draws lots together. The department director has four lottery draws, two deputy directors, and the attending and hospitalization are the same lottery draws. After drawing, call the family and explain a few words, and you have to go to rescue the person immediately. This is the rule for treating patients with high risk of infection in the hospital. Doctors who have not drawn draws will draw one person as the second batch as preparation. If the first batch of doctors cannot continue to perform their duties due to... some reasons, then the second batch of doctors will take the lead.

In the face of probability, all beings are equal.

"Okay, okay, what are you going to draw together?" Huang Wenhui, the chief director of the respiratory department, dispersed everyone who was preparing to draw lots without hesitation. "What's the point of drawing? Go whatever you need to do, I'll do it."

Director Huang is 43 years old this year. He is not tall, about 1.5 meters tall. But in the one-acre and three-point field in the respiratory department, Director Huang is the one with the most rules. Not only is he very rules, but he also has a big temper. When her eyelids are low, the best way to deal with mistakes is to admit your mistakes before she appears. If Director Huang finds your fault, it is not something that can be passed in one or two sentences. According to the experience of the department, Director Huang can remember the problem of "the content of the case record is not objective enough" for at least three years. And from time to time, he will teach the person who makes mistakes a lesson.

Such a serious person is generally less popular. Director Huang Wenhui is no exception. Anyway, according to the rules, Director Huang has four signs to draw, and no one has any objection. But who knew that Director Huang made such a decision this time.

"What do you do? Want to steal?" Director Huang is from Guangdong. He is black, thin and short. He doesn't look like a person who has given birth to a child anyway. "Let you guys take care of the plague patients, that's harmful to others and yourself. Maybe he will kill the person." She glared at her eyes, "If you don't have the ability, don't rob me!"

The respiratory department exchanged glances with each other. They were not sure whether Director Huang was really angry or tried to make everyone accept this fact through this statement.

"I am the department director, a party member, my child is in junior high school, and I have an older brother at home." Director Huang laughed and poked his hand to his waist, "Who can compare to me? Okay, get out of here quickly. When I come back, I will check the case!" After that, Director Huang turned around, walked out of the office very casually, and walked towards the stairwell.

After confirming that there was no one around him, Huang Wenhui took out her cell phone with a trembling hand and called her husband out, and her voice was trembling.

"There is a plague, I want to go to the consultation. You are cooking for the child these days." Director Huang's voice was trembling very violently, "It's okay, I'm fine, I...I'm not afraid!"

In the year of SARS, Director Huang had just graduated from undergraduate degree and entered the First Affiliated Hospital of Ningyuan Medical College. In that year, the First Affiliated Hospital was designated as a designated treatment hospital for SARS cases in Song'an Province.

"That's what Teacher Hou said that year. He can do it, I... I can do it too!" Director Huang said this and hung up the phone resolutely. He wiped his eyes with his sleeves, stomped his feet, and ran towards the emergency department rescue hall.

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Chapter completed!