152: Chapter 152 The Patient Standing on the Edge of a Cliff
7:45 PM.
A white ambulance stopped at the entrance of the Emergency Department.
The stretcher was pushed down.
Lu Chen was already standing at the entrance of the Red Zone.
The person on the stretcher was breathing with the help of a transport ventilator, with ECG monitoring electrodes attached to their body and three intravenous lines in their arms.
A forty-six-year-old man.
His complexion was sallow, his sclera deeply jaundiced, and his abdomen distended.
This was the typical appearance of a patient with end-stage liver cirrhosis.
Two people followed behind the stretcher.
One was a transport doctor from the Provincial Peoples Hospital, wearing a white coat and holding a stack of medical records.
The other was a young man.
He looked about eighteen years old, wearing a gray hoodie, with a thin build and a poor complexion.
His eyes were red as he followed closely beside the stretcher, one hand supporting his father's arm.
Lu Chen glanced at the young man.
This was the patient's son.
The eighteen-year-old boy who wanted to donate his liver.
"Push him in."
Lu Chen stepped aside, and the stretcher was pushed to Resuscitation Bed No. 1.
Meng Yan quickly stepped forward with two Nurses to connect the monitoring equipment and check the intravenous lines.
The transport doctor from the Provincial Hospital walked up to Lu Chen.
"Hello, I am Jiang Wei, a Resident Physician from the Department of Gastroenterology at the Provincial Peoples Hospital, responsible for this patient's transport."
"Lu Chen, Resident Physician in the Emergency Department. I'll be taking over this patient."
"Alright."
Jiang Wei handed over the medical records.
"Your director should have already briefed you on the basic situation. These are the detailed medical records and all recent test reports."
Lu Chen took them and flipped through them quickly.
"When was the last gastrointestinal bleed?"
"Three days ago. At that time, there was about a thousand milliliters of blood loss. It was controlled using Terlipressin and Omeprazole, and he has been under observation since."
"Is the cause of the bleeding clear?"
"A gastroscopy was performed. He has grade three esophageal varices and grade two gastric fundal varices. Three days ago, it was a rupture and bleeding of the lower esophagus."
"Has he undergone ligation or sclerotherapy?"
"He had one ligation, but the results weren't ideal. The portal vein pressure was too high, and there was another minor bleed the day after the ligation."
Lu Chen frowned slightly.
"When was the last coagulation function test?"
"It was checked this morning. PT 28 seconds, INR 2.7, fibrinogen 1.1g/L, platelets 43,000."
Every single item pointed to the same conclusion.
His coagulation function had completely collapsed.
This patient didn't just have an ordinary gastrointestinal bleed; his problem was that his coagulation system had been dragged down by his severely damaged liver.
Even if this bleeding was stopped, as long as there was no fundamental improvement in coagulation function, another bleed could occur at any time.
And every instance of bleeding could be fatal.
"What is the current grade of hepatic encephalopathy?"
"Grade two. He is conscious, but has decreased calculation ability and inverted sleep patterns. Asterixis is positive."
"What is the albumin level?"
"21g/L."
"And the ascites?"
"Moderate amount. A paracentesis was performed last week to drain two thousand milliliters."
Lu Chen closed the medical records.
"Understood."
He turned to look at the patient who had been settled in.
[Eye of Truth scan complete]
[Patient Information: Male, 46 years old]
[Chief Complaint: Recurrent upper gastrointestinal bleeding for one month, worsening for three days]
[Eye of Truth diagnosis: Decompensated liver cirrhosis (mixed factors of alcoholic + hepatitis B virus), Grade III esophageal and gastric varices (recent history of rupture and bleeding), Grade II hepatic encephalopathy, Ascites (moderate), Severe coagulation dysfunction (multi-factor deficiency), Hypoalbuminemia, Pancytopenia due to hypersplenism]
[Danger Level: Extremely High (S-rank)]
[Current Symptoms: Blurred consciousness but rousable, deep jaundice of the sclera and skin, abdominal distension (ascites), splenomegaly, positive asterixis, edema in both lower limbs]
[Recommendations: Focus on intensive monitoring, maintain stable vital signs, correct coagulation function (Fresh Frozen Plasma + Prothrombin Complex Concentrate), preventively reduce portal vein pressure (Terlipressin maintenance), control hepatic encephalopathy (Lactulose + Rifaximin), supplement albumin to correct hypoalbuminemia, closely monitor for signs of bleeding]
[Warning: The patient's current state is extremely unstable. The risk of re-bleeding within 72 hours is very high (system assessment probability 68%). Any moderate amount of bleeding or more will be extremely difficult to control under current coagulation conditions, with an extremely high risk of death. The only curative solution is Liver transplantation]
The assessment results given by the system were completely consistent with the clinical judgment.
This patient was currently standing on the edge of a cliff.
Lu Chen walked to the bedside.
"Mr. Wang."
The patient slowly opened his eyes and looked at Lu Chen.
His eyeballs were deeply jaundiced, and his pupil response was normal but sluggish.
"You are now in the Emergency Department of Jiangcheng City Central Hospital. I am the doctor responsible for your subsequent treatment. Can you hear me?"
The patient nodded slightly.
His voice was very weak.
"I can hear you."
"Do you know what your situation is?"
"I know... my liver is failing."
Lu Chen nodded.
"We will do everything we can to stabilize your condition. What you need to do now is cooperate with the treatment, don't move around, and tell the Nurse immediately if you feel any discomfort."
The patient nodded again.
Then his gaze shifted to the young man standing nearby.
His eighteen-year-old son.
"Xiao Hui..."
The young man immediately leaned in and held his father's hand.
"Dad, I'm here. Don't talk anymore, just rest well."
His voice was trembling.
Lu Chen glanced at the boy.
Eighteen years old.
His eyes were bloodshot, but he had been holding back his tears.
His hand held his father's, his knuckles turning white.
Lu Chen looked away.
He walked to the Nurse Station.
"Sister Meng, I've issued the medical orders. Maintain Terlipressin via micro-pump, give Omeprazole via IV push every eight hours, Lactulose orally and via enema, Rifaximin orally, 20g of Human Albumin via IV drip, and prepare 800ml of Fresh Frozen Plasma, dripping 400ml first."
Meng Yan asked while taking notes.
"Should we administer coagulation factors?"
"Let's check the coagulation function first to see if there were any changes during transport. If it's worse than this morning's results, we'll use Prothrombin Complex Concentrate."
"Alright."
"Also, call Professor Feng from the Department of Gastroenterology to come over. Director Li mentioned they would cooperate, so have Professor Feng take a look at the patient's condition."
"I'll contact him immediately."
After finishing the medical orders, Lu Chen returned to Resuscitation Bed No. 1.
The patient's son was still standing there.
"What's your name?"
The young man looked at Lu Chen.
"My name is Wang Hui."
"Wang Hui, do you understand your father's situation?"
"I understand a bit. The doctors at the Provincial Hospital told me that my father needs a liver transplant."
"Mm, do you know about living donor transplantation?"
Wang Hui nodded.
"I've already decided. Use my liver."
His voice was very low, but his tone was firm.
Lu Chen looked at him.
An eighteen-year-old boy.
There was fear in his eyes, but even more of an unshakeable stubbornness.
"The transplant is still in the discussion stage. An expert team from the province will come to perform an assessment. Until then, my task is to stabilize your father's condition."
"Dr. Lu, can my dad... hold on until that day?"
Lu Chen looked him in the eye.
"I will do my best."
Wang Hui's lips trembled.
"Thank you."
Then he gripped his father's hand tightly again.