Critical care referral: the last glimmer of hope in a desperate situation
A month ago, Mr. Chen, aged 87, received emergency treatment in an external hospital due to acute respiratory failure and lung infection. Despite being assisted by a non-invasive ventilator, his condition remained unchanged and he was unable to be successfully weaned from the ventilator. It was recommended to transfer him to the intensive care unit (ICU) for treatment.
Considering the elderly man's advanced age, his family members were unwilling to let him be isolated and treated alone in the ICU. With a hesitant attitude of "giving it a try", they urgently transferred Mr. Chen, who was unconscious and still wearing a non-invasive ventilator, to the emergency room of the Cardiac Rehabilitation Department at Hainan Chengmei Hospital.
"I don't want him to spend his last moments alone in the ICU, but I also don't want to give up. Even if there's only a glimmer of hope, I want to give it a try." The words of the family members are filled with concern and persistence.
Professor Zheng Yin, the Vice President and cardiovascular and cerebrovascular expert of Hainan Chengmei Hospital who received the case, immediately opened the green channel, and the cardiac rehabilitation team assembled in the first place. At this time, Mr. Chen was breathing weakly and unconscious, and the continuously low blood oxygen level on the monitor indicated that his life was rapidly slipping away.
While the team was doing its utmost to maintain the basic vital signs of the elderly patient, they quickly coordinated with experts from the ICU and respiratory medicine for an emergency consultation. Based on multiple critical conditions such as coma, hypoxemia, pulmonary infection, rapid atrial fibrillation, and acute heart failure, a preliminary rescue plan was formulated.
After two full days of high-intensity treatment, Mr. Chen finally barely escaped from the danger of life - his hypoxemia was corrected, his atrial fibrillation turned into normal sinus rhythm, and his consciousness gradually recovered. After another four days of meticulous care, the elderly man successfully weaned off the ventilator, smoothly transferred out of the general ward, and embarked on the road of cardiopulmonary rehabilitation.
Multidisciplinary collaboration: tackling the challenges of emergency treatment for elderly patients
"Advanced age itself is a major challenge in clinical treatment, and when combined with multi-system dysfunction, every step of treatment can have a ripple effect throughout the body," Professor Zheng Yin admitted. Elderly patients have weakened immunity, and lung infection is extremely prone to induce acute exacerbation of heart failure, forming a vicious cycle. Only through rapid and precise assessment and balanced treatment priorities can we strive for survival for patients.
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To overcome this challenge, Professor Zheng Yin's team broke the limitations of treating a single disease and tailored a personalized plan for Mr. Chen:
Precise control: Select targeted anti-infective and antifungal drugs to block the spread of infection at its source;
Stabilization cycle: Implement diuretic and anti-heart failure treatments, while simultaneously correcting electrolyte imbalance, anemia, hypoproteinemia, and abnormal liver function;
Safe medication: Dynamically monitor core indicators such as liver and kidney function, blood routine, etc., adjust medication dosage in real-time, and avoid additional burden on the liver and kidneys caused by drug interactions.
Nutrition and rehabilitation go hand in hand to facilitate recovery
The recovery of critically ill patients has never been about "only treating without nurturing". The team at Hainan Chengmei Hospital adheres to the concept of "full-cycle management", promoting nutritional support and rehabilitation training alongside clinical treatment.
Nutrition experts have formulated an enteral nutrition prescription that is high in protein and easy to digest, tailored to the elderly's condition. This prescription aims to gradually improve their malnourished state and reserve physical strength for rehabilitation training;
Rehabilitation therapists break the misconception that "severe patients need absolute rest", and conduct one-on-one training by the bedside in a gradual and orderly manner - starting with limb flexion and extension, basic breathing exercises, and gradually transitioning to swallowing function recovery. They also provide hands-on guidance on pursed lip breathing and abdominal breathing techniques, comprehensively improving the elderly's respiratory function.
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After a period of systematic treatment and rehabilitation intervention, Mr. Chen's vital signs gradually stabilized, and he was successfully discharged home for rest and recuperation a few days ago.
Experts say
The treatment of elderly patients with severe conditions involves a full cycle of work that spans "prevention - treatment - rehabilitation".
The Cardiac Rehabilitation Department of Hainan Chengmei Hospital has always adhered to the concept of individualized and precise diagnosis and treatment. Relying on multidisciplinary collaboration, it tackles the challenges of treating elderly patients, not only striving to save lives but also endeavoring to help patients restore a high quality of life. With professionalism and warmth, it safeguards the health of every patient.
Expert Introduction
Zheng Yin, Chief Physician
Vice President, Professor
Master's supervisor, scholar studying in the United States
Outstanding Experts with Outstanding Contributions in Hainan Province
Medical expertise
Specialized in the prevention, diagnosis, treatment and rehabilitation of cardiovascular and cerebrovascular diseases, as well as geriatric diseases, and health management. Conduct cardiac rehabilitation for patients with hypertension, coronary heart disease, arrhythmia, heart failure, metabolic syndrome, after stent implantation, and after bypass surgery, including guidance on medication, exercise, nutrition and sleep disorders.