In the pharmacy cabinet next to D, a yellow needle was taken out by the doctor who ran in. "Amiodarone is ready for a quick static push! 300 mg! With that, he pulled up a tube on D's bed with a yellow plastic connector — the end of the indwelling needle on D's body — with the hand that didn't remove the needle, and quickly pushed the yellow liquid into it.

Amiodarone, the most common and widely used anti-arrhythmic drug, is known for its versatility, and although it has quite a few side effects, it can only be cardioverted with such a crude drug in the current situation.

But this didn't seem to be working as it should, because the warning sound of the ECG monitor's "jingle jingle bell" quickly turned into a more shrill beep and a high-frequency "beep" reverberation, and the dense sine waveform that was still regular became extremely dense irregular sawtooth.

Ventricular fibrillation, compared to the previous ventricular tachycarcity, where the myocardium only beats continuously at an extremely fast speed, the ventricular muscles at this time have completely entered the final state of madness, and there is no longer any rhythmic joint action, leaving only the parts of the myocardium to fight irregularly - in this case, the heart is completely unable to perform normal functions.

“V-fib！ (ventricular fibrillation)" After a brief report of the new condition, the doctor threw the injected amiodarone syringe far away, grabbed the defibrillator's conductive glue from the plate above the medicine cabinet, unscrewed the cap, and sprayed it vigorously on an electrode plate. Then, he grabbed the two electrode plates with both hands, rubbed each other a few times to make the conductive glue cover the two electrode plates, and then attached the two electrode plates to the position below the right collarbone and under the left breast, which D is always exposed - the positive and lateral electrode placement method "200 joules!" ”

As the gradually harsh charging sound suddenly disappeared, D's body bounced up, and then fell back to the ground heavily - the principle of defibrillation is to release thousands of volts of strong current to the heart through the electrode plate, so that the various ventricular muscles that are fighting each other are quickly depolarized under such high-intensity stimulation, and enter a brief refractory period of complete calm. Subsequently, when the ventricular muscles reactivate, the pacemaker with the highest automaticity (usually the sinus node) is likely to resume the task of dominating the heart's beat.

————————

Author: In short, the concept of ventricular fibrillation and defibrillation I can express it with the following example.

Normal beating: A group of students reading the text aloud in unison

Room speed: I don't know why, everyone suddenly reads very fast, but it's still synchronized

Ventricular fibrillation: Everyone is completely confused, everyone is reading different passages at different speeds, and the scene is extremely chaotic

Defibrillation: The teacher angrily knocked on the blackboard with a teaching stick, and everyone was so frightened that they quickly shut up.

Defibrillation success: After everyone has quieted down, the Chinese class representative or class leader suddenly starts to read the text again in a low voice, and the other students will gradually follow the class representative and read the text back to the normal state

————————

"Invalid!" After confirming that the heart rate had not recovered, the doctor immediately reported it and restarted the charge.

"The second time." The second doctor had already rushed in, and as he spoke, he also ran to the pharmacy cabinet and grabbed a stick of adrenaline.

"Bang-" The second shock also ended in failure.

"Turn him over!" The doctor roared, and the second doctor reacted and pushed D to the lateral position, exposing his back to the electrode plates.

In addition to the anterior lateral position previously used, there is also a pattern of plate placement known as the anteroposterior position: the plate position below the left breast remains unchanged, while the plate below the right clavicle is moved to the right of the posterior center. Generally speaking, anteroposterior and anterior lateral placement methods have a complementary relationship, and when one is ineffective, there may be surprises when the other is used.

"Bang!" Disappointingly, however, the third shock still failed to change the state of ventricular fibrillation.

But before they could make their fourth attempt, the frantic fold of ventricular fibrillation quieted down on its own.

Of course, this does not mean that it is almost impossible for the terminal ventricular fibrillation to recover on its own, but rather that it is like a dance plague, a death after a crazy dance.

The sound like a death knell made the other doctors who were already rushing to this side stop in place, and the second doctor who quickly pushed the adrenaline into it had already shown a gloomy look, leaving only the first doctor still doing cardiopulmonary compressions.

Time of death, 22:27.

…………

When the patient dies, many tests are performed, and the final results are presented to the others.

[Primary amoebic meningitis], acute meningitis caused by the Naegleria subtype of free-living amoeba - the final result was given by a deep biopsy of the white matter directly in the deeper part of the brain, and the trophozoite morphology of the amoeba was observed under the microscope.

"So, why are we here this time?" Putting on the protective suit again, Qianyu, who was obviously still in a daze after being told the cause of D's death, asked.

"Amoebas are not very transmissible, and generally speaking, at least water should be allowed to enter the nasal passages." Grigory said as he turned on the light. "I can understand if that family is infected, but D doesn't have much contact with water, how did he get infected?"

"Could it be the time to take a water sample? For example, the faucet ......"

"He shouldn't make that mistake...... Grigory said as he suddenly walked in the direction of the away guard. Unless you want to wash your hands after using the toilet. But generally speaking, it is difficult for this kind of living water in a room to spread amoeba, but I think we can test it. ”

Although in humans, amoebas are difficult to detect – cerebrospinal fluid cultures are rarely successful. However, if you are testing for traces of amoebas in water, all you need is a light microscope, a few minutes and a sufficiently experienced observer.

But after such a round of inspections, they could not find any traces of amoebas in the water in the water of the sink faucet in the master and guest bathrooms. If the amoeba could not be observed without turning on the tap for several days in a row, then it was even more unlikely that there was an amoeba when D used water a few days ago.

In such a situation, both Gregory and Thousand Feathers thought of the last place, which was also likely to be the solution to everything.

……

"I think we're supposed to bring the water sample back, right?" Qian Yu stood next to Gregory, looked at the arrangement in the flower room, and said this. "Didn't the inspection find anything?"

"No, and even now, there are no amoebas." Gregory was also staring at the set in the flower room. "If it weren't for the fact that I couldn't think of any other possibility, I wouldn't have brought you back here."

"yes, we're really—" Chiba's words stopped abruptly, and his gaze focused on the water pipe on the ceiling.

The analysis function of the auxiliary unit told him that the flower room had two separate piping systems, and that the water samples they had collected here came from the flower room's sink. In contrast, the sprinkler irrigation system on the ceiling of the flower room is connected to a different set of pipes.

"The pipes above, we don't seem to have the pipes to inspect the sprinkler system for watering – not the tap water system."

"What......" Gregory looked up as if from a dream.

"Looks like we've found the answer?" Chiba said as she looked at the end of the pipe, a hole that led to the top of the sheet metal ceiling.

This is the top floor of the entire building, and if the roof drain is connected to the hidden cistern that belongs to the house hidden above the ceiling...... I'm afraid that anyone who is not familiar with this building will be able to detect this, let alone check if there are a large number of amoebas inside.

————————

In fact, the treatment regimen for primary amoebic meningitis is similar, with several drugs led by amphotericin B. The reason why D died after taking the medicine was because the disease itself was relatively difficult to treat, and even if he took the medicine, it was difficult to save him.

Also, the reason why D worsens faster is because ABC both have Legionnaires' disease, and Legionnaires' disease more strongly stimulates the work of the immune system and slows down the ravages of amoebas. D's immune system is not working well, which is why the indication for infection in the brain biopsy is negative.