112: Chapter 112 Both the outcome and the process are important, but the most important thing is that the patient survives.
Lu Chen did not look at Associate Chief Physician Chen Minghao, nor did he look at Section Chief He Zhongfeng.
His eyes were only on the patient and the screen.
[enemy of yama (Primary) effect in effect, the rate of decline in the dying patient's vital signs has slowed by 50%]
The patient's blood pressure was still low, but the rate of decline had noticeably slowed down a bit.
Lu Chen took a deep breath.
"Patient, can you hear me?"
The woman's eyelids twitched.
"Yes..."
"In a moment, when I tell you to exhale, breathe out slowly. Don't strain yourself. I will be very quick."
"Okay..."
Lu Chen placed the probe on the lateral apex of the heart and adjusted the angle slightly.
On the screen, a very narrow fluid-filled dark area appeared.
The heartbeat, the sliding of the lung margin, and the pulling of the septum—the entire window appeared only briefly at the end of exhalation.
Associate Chief Physician Chen Minghao stood to the side, his eyes locked firmly on the screen.
The approach he had just rejected actually had a window.
And Lu Chen had found it with great precision.
Lu Chen said in a low voice, "Get ready."
Zhao Yaqin reported, "The monitor is stable at a low level, blood pressure is 59/36, heart rate is 160."
Lu Chen said, "Exhale."
The patient exhaled with difficulty.
The window opened.
One second.
Lu Chen inserted the needle.
The tip of the needle appeared clearly on the ultrasound screen, advancing steadily along the predetermined angle.
No deviation.
No hesitation.
No unnecessary movements.
The needle tip avoided the lung margin and entered the pericardial septal cavity by grazing the edge of the septum.
Aspiration.
Dark red fluid entered the syringe.
"Inside the cavity."
Many people in the Resuscitation Room held their breath simultaneously.
Lu Chen did not stop.
"Aspirate fifty milliliters."
Zhao Yaqin immediately complied.
Fifty milliliters of effusion were slowly withdrawn.
On the monitor, the blood pressure began to rise.
65/40.
72/45.
The patient's respiratory rate began to drop.
Lu Chen continued, "Guidewire."
Shen Xiaoning handed over the guidewire.
Lu Chen steadied the needle body with his left hand and inserted the guidewire with his right.
Under ultrasound guidance, the guidewire successfully entered the target cavity, then passed through a connecting opening into the main cavity.
Associate Chief Physician Chen Minghao's pupils contracted slightly.
This step was even more difficult.
If the Puncture just now was life-saving, then the adjustment of the guidewire was the key to determining the effectiveness of subsequent drainage.
Yet, Lu Chen was so steady that there was nothing to fault.
"Dilate the skin."
"Place the catheter."
"Connect the drainage bag."
The effusion flowed out along the tubing.
The monitor's alarm gradually ceased.
Blood pressure was 88/56.
Heart rate was 128.
Blood oxygen was 94.
The patient's eyes regained some focus, and her chest heaving was not as intense.
"I... I feel much better..."
The patient's husband covered his face and squatted on the floor, crying.
"Thank you, doctor, thank you, doctor!"
Lu Chen secured the drainage tube.
"Continue monitoring blood pressure and drainage volume, transfer to the ICU to evaluate lupus activity, complete immunological and infection markers, and conduct a joint consultation with the Cardiology Department and the Department of Rheumatology and Immunology."
Zhao Yaqin immediately replied, "Understood."
Director Li Sen looked at the monitor and finally breathed a sigh of relief.
"Beautiful."
Wu Fan whispered, "That's not just beautiful; that's absurd."
Sun Ji added in a low voice.
"It's absurd to the point of being ridiculous."
Zhao Yaqin turned her head and glared at him.
"Shut up."
Sun Ji immediately shut his mouth, but the excitement on his face could not be hidden.
Shen Xiaoning handed the gauze to Lu Chen, her eyes shining brightly.
"Dr. Lu, gauze."
"Mm."
Lu Chen took the gauze and pressed to secure it.
He stood by the bed, his white coat cuffs clean, his voice still calm.
"The patient is not yet completely out of danger, so don't relax yet; watch out for re-accumulation of fluid and arrhythmias."
Director Li Sen nodded.
"Do as Lu Chen says."
In the Resuscitation Room, the staff of the Central Hospital quickly got to work.
Meanwhile, Associate Chief Physician Chen Minghao stood to the side, his whole body somewhat stiff.
Just now, he had failed in front of everyone.
Then Lu Chen took over.
One needle into the cavity.
Guidewire into the main cavity.
Catheter placement successful.
Patient stabilized.
Everything happened too fast and too directly.
There was no room for argument.
There was no room for explanation.
The few doctors from the Provincial Peoples Hospital nearby were all silent.
It wasn't that they didn't understand.
It was precisely because they understood that they were even more silent.
Section Chief He Zhongfeng's expression was extremely ugly; just a moment ago, he had been thinking about having Associate Chief Physician Chen Minghao provide on-site teaching.
Now, there was indeed on-site teaching, but the one doing the teaching had become Lu Chen.
Director Li Sen turned around and looked at Associate Chief Physician Chen Minghao.
"Associate Chief Physician Chen Minghao, the patient still requires follow-up treatment. Our Emergency Department needs to get to work, so we won't be able to accompany you all on your tour."
This sentence was very polite.
But it carried quite a sting.
Associate Chief Physician Chen Minghao's lips moved.
"Just now... Dr. Lu's procedure was indeed completed very well."
Sun Ji's eyes lit up, and he whispered, "Oh, he's loosening his tongue?"
Associate Chief Physician Chen Minghao heard him but did not retort.
He was in no position to retort now.
Lu Chen took off his gloves and looked at Associate Chief Physician Chen Minghao.
"Associate Chief Physician Chen Minghao, your reasoning for choosing the left parasternal approach just now was sound, but the patient's respiratory status and the dynamic obstruction of the lung margin were too pronounced, making the actual window unstable."
When these words were spoken, many people in the Resuscitation Room were stunned for a moment.
Associate Chief Physician Chen Minghao was also stunned.
He hadn't expected Lu Chen to give him a way out.
If Lu Chen had stepped on him publicly right now, no one could have said Lu Chen was in the wrong.
But Lu Chen did not.
Lu Chen just stated the technical facts.
Associate Chief Physician Chen Minghao was silent for a long time, his voice lower.
"Your choice of the lateral apical approach just now was a very accurate judgment."
Lu Chen nodded.
"In an Emergency Department setting, both results and processes are important, but the patient surviving is the most important."
Associate Chief Physician Chen Minghao's face turned slightly pale.
This sentence was the perfect response to the things he had said in the Conference Room just moments ago.
Results cannot represent everything.
But without results, all protocols are meaningless.
Director Li Sen glanced at Lu Chen, his eyes filled with gratification.
He liked this young man's skills, and he also liked that this young man didn't waste words at critical moments.
President Zeng Dayang had also arrived at the Red Zone by this time, and after understanding the situation, he looked at Lu Chen with even greater satisfaction.
Vice President Peng Zhao stood behind, his expression not looking good.
Section Chief He Zhongfeng kept his head down, trying his best to minimize his presence.
He just wanted to stuff himself into a resuscitation cart drawer right now.
After the resuscitation reached a pause, the patient was sent to the ICU.
The Red Zone resumed normal operations.
The exchange team from the Provincial Peoples Hospital had originally arranged lunch and an afternoon discussion, but Associate Chief Physician Chen Minghao no longer had the mood to stay.
After returning to the Conference Room, he spoke a few brief words.
"Today's on-site resuscitation in the Emergency Department of Jiangcheng City Central Hospital has also brought me some new thoughts."
"Especially regarding the emergency management of complex pericardial effusion, it really requires dynamic decision-making combined with the patient's real-time status."
This was spoken very officially.
But everyone could hear that his momentum was gone.
Section Chief He Zhongfeng still wanted to force a recovery.
"Associate Chief Physician Chen Minghao, why don't we continue to have an in-depth discussion about that case from just now this afternoon?"
Associate Chief Physician Chen Minghao glanced at him.
"No need. Patient treatment is the priority. Let's discuss it after the case data has been organized later."
Section Chief He Zhongfeng nodded awkwardly.
"That's fine, that's fine."
Associate Chief Physician Chen Minghao looked at Director Li Sen.
"Director Li Sen, today's exchange was very fruitful. We at the Provincial Peoples Hospital have arrangements this afternoon, so we will be heading back now."
Director Li Sen nodded.
"Thank you for your hard work, Associate Chief Physician Chen Minghao."
Associate Chief Physician Chen Minghao looked at Lu Chen again.
This time, his gaze was much more complex.
"Dr. Lu, regarding that comment online, my wording was somewhat imprecise."
The Conference Room went quiet instantly.
Lu Chen looked at him.
"If Associate Chief Physician Chen Minghao is willing to say that, I accept it."
Associate Chief Physician Chen Minghao was silent for a moment.
"After your paper is published, I will read it carefully."
"I welcome your corrections."
Associate Chief Physician Chen Minghao nodded and said nothing more.
He led the people from the Provincial Peoples Hospital out of the Conference Room.
When they walked out of the Hospital building, the morning sun was somewhat blinding.
The young doctor following behind him whispered, "Associate Chief Physician Chen Minghao, that Lu Chen from just now is really strong."
Associate Chief Physician Chen Minghao stopped in his tracks.
He didn't turn back, only saying one sentence.
"Mm."
The young doctor dared not say anything more.
After getting into the car, Associate Chief Physician Chen Minghao took out his phone and clicked on the comment he had made yesterday.
The likes were still increasing.
The comments were still arguing.
He watched for a long time, but ultimately did not reply again.
The car started.
The building of the Jiangcheng City Central Hospital gradually faded into the distance.
Associate Chief Physician Chen Minghao closed his eyes, his face weary.
He knew that after this incident spread today, the one who would lose face would be him.
But what made him feel even worse was that he had confirmed one thing with his own eyes.
That twenty-four-year-old Resident Physician was not just hyped up.
He was truly strong.
And so strong that one couldn't remain stubborn for too long.