153: Chapter 153 Do you think this patient can wait for a transplant?
Lu Chen turned around and returned to the workstation.
He picked up a pen and began writing the admission assessment record in the medical history book.
“Patient Wang Jianguo, male, forty-six years old, admitted to our hospital's Emergency Department Red Zone from Provincial Peoples Hospital due to recurrent upper gastrointestinal bleeding for one month, worsening for three days.”
While writing the medical record, another matter was running through his mind simultaneously.
The risk of re-bleeding within seventy-two hours was 68%.
This number was very high.
In other words, in the next three days, this patient had nearly a seventy percent probability of bleeding again.
Once bleeding occurred, given his current coagulation function, stopping it would be extremely difficult.
Everything had to be prepared before the bleeding started.
Hemostatic drugs, Sengstaken-Blakemore tubes, emergency reserves of plasma and coagulation factors, and contact information for emergency gastroscopy.
Every link had to be foolproof.
Professor Feng Yuan from the Department of Gastroenterology arrived forty minutes later.
The old professor, in his fifties, had graying hair, wore reading glasses, and had a gentle personality.
“Xiao Lu, I’ve looked at this patient’s data; it is indeed very tricky.”
“Professor Feng, could you take a look at the current medication regimen and see if anything needs adjustment?”
Professor Feng put on his reading glasses and flipped through the medical records and medication logs.
“The dosage of Terlipressin can be increased slightly. The Portal Vein pressure needs to be suppressed further; otherwise, the risk of variceal rupture won't come down.”
“Increase it to how much?”
“Increase it to one milligram every four hours.”
“Okay.”
Professor Feng then looked at the abdominal ultrasound report.
“The amount of ascites is significant, and the Albumin is only 21. We must continuously supplement Albumin to raise the colloid osmotic pressure; otherwise, the ascites won't be suppressed.”
“I prescribed 20g of Albumin once a day. Is that enough?”
“Not enough. Increase it to twice a day. Use it for five consecutive days and then re-examine.”
“Okay.”
Professor Feng closed the medical record.
“Xiao Lu, what I fear most for this patient is a sudden massive hemorrhage. You need to keep a 24-hour watch here. Once bleeding occurs, hemostatic measures must be applied immediately.”
“I know.”
“Additionally, controlling hepatic encephalopathy is critical. He is currently at Grade 2. If it progresses to Grade 3 or 4 and his consciousness deepens, airway protection will become a major issue.”
“Lactulose and Rifaximin have already been administered.”
“Hmm, add L-ornithine L-aspartate to help lower blood ammonia.”
“Okay.”
Professor Feng stood up.
“I'll come by again tomorrow morning. Call me anytime if something happens.”
“Thank you, Professor Feng.”
After Professor Feng left, Lu Chen added the adjusted medical orders.
Meng Yan prepared the medication and hung the IV bag.
By 10:00 PM, the patient's vital signs were temporarily stable.
Heart rate 88 bpm, blood pressure 105/65 mmHg, oxygen saturation 97%.
It was slightly better than when he first arrived.
The Terlipressin was working; the Portal Vein pressure was slowly decreasing.
But this was only temporary.
Lu Chen knew the real test had not yet begun.
He sat at the workstation, monitoring the data from Bed 1 while continuing to flip through his books.
He re-read the chapter on massive gastrointestinal bleeding in the Emergency Medicine textbook.
He mentally simulated the key operation points of the Sengstaken-Blakemore tube three times.
He also silently memorized the emergency endoscopic hemostasis procedure twice.
...
11:00 PM.
Wang Hui was still standing by his father's bedside.
He hadn't sat down once.
Lu Chen glanced at him.
“You should go rest. There are Nurses watching here.”
“I'm not tired.”
“Even if you aren't tired, your dad needs a quiet environment. If you stand here, he won't be able to sleep soundly.”
Wang Hui hesitated for a moment.
“Then I'll go sit in the hallway for a while.”
“There's a family lounge nearby. Go lie down there. The Nurse will call you if anything happens.”
Wang Hui nodded, took one last look at his father, and turned to walk out.
Lu Chen turned back.
Meng Yan walked over.
“This kid really makes one's heart ache. An eighteen-year-old boy, still half a child himself, and he has to donate his liver to his dad.”
“Yeah.”
“Lu Chen, tell me, do you think this patient can wait until the transplant?”
Lu Chen didn't answer.
He watched the waveforms pulsing on the monitor.
“Sister Meng, notify the night shift Nurses. This patient's gastric tube needs to be aspirated every two hours to check for coffee-ground liquid or fresh blood.”
“Okay.”
“Also, if his blood pressure drops below 90/60, call me immediately.”
“Understood.”
“I won't be going back to the Duty Room tonight; I'll stay here at the workstation.”
Meng Yan looked at him.
“You're going to watch all night?”
“Yeah, I have to watch at least the first night. This patient is too unstable.”
Meng Yan sighed.
“Alright then, I'll have the Nurse brew a cup of coffee for you.”
“Thanks, Sister Meng.”
1:00 AM.
The Red Zone had quieted down.
The sounds of ventilators and monitors were the only background noise.
Lu Chen leaned against the back of his chair, his eyes half-closed.
He wasn't sleeping.
He was listening.
The beeping of the monitors, the rhythmic hiss of the ventilators—the rhythm formed by these sounds was a direct reflection of the patients' vital signs.
As long as the rhythm didn't change, everything was fine.
The phone by his hand vibrated.
A message from Shen Xiaoning.
[Xiao Ning: Dr. Lu, aren't you asleep yet?]
[Lu Chen: No, I'm watching over a patient.]
[Xiao Ning: Are you on the night shift tonight?]
[Lu Chen: It's not exactly a shift; the patient's condition is just special, so I need to keep an eye on him.]
[Xiao Ning: Then take care of yourself, don't get too tired.]
[Lu Chen: Mm.]
[Xiao Ning: I'll bring you an extra breakfast tomorrow morning. You must eat it all!]
[Lu Chen: Okay.]
[Xiao Ning: Goodnight Dr. Lu, see you tomorrow.]
Lu Chen didn't send the message immediately after typing it.
He looked at the word "Goodnight" on the screen.
Then he sent it.
[Lu Chen: Goodnight.]
...
3:00 AM.
The night shift Nurse came over to report.
“Dr. Lu, the liquid aspirated from the gastric tube is dark in color, a bit like coffee grounds.”
Lu Chen's eyes snapped open.
He walked quickly to Bed 1.
He took the tube and glanced at the liquid.
The color was indeed dark, but it wasn't the bright red of fresh blood.
It was old blood residue.
“It's not new bleeding; it's the appearance of residual blood from before, after being acted upon by gastric acid.”
The Nurse breathed a sigh of relief.
“So it's fine?”
“For now, but we must continue monitoring. Aspirate again in two hours. If it turns bright red, call me immediately.”
“Okay.”
Lu Chen watched by the bedside for a while longer.
The patient was in a light sleep; his complexion was still sallow, but his breathing was steady.
The data on the monitor: heart rate 82, blood pressure 100/62, oxygen saturation 96%.
Not bad.
He was holding steady for now.
Lu Chen returned to the workstation and picked up the Emergency Medicine textbook.
He flipped to the chapter on Cardiopulmonary Resuscitation.
His progress in Cardiopulmonary Resuscitation was only at 16/100.
The improvement of this skill mainly depended on practical application; simply reading books increased it slowly, but it was better than nothing.
He read for about half an hour.
His eyelids began to feel heavy.
The effect of the genetic enhancement serum allowed his energy to recover much faster than an average person, but after working from 8:00 AM to 3:30 AM, even a man of iron had to rest.
Lu Chen closed his eyes.
It wasn't sleep, but a brief recovery.
His ears still automatically captured the sounds of the monitors.
5:00 AM.
The Nurse came to report.
“Dr. Lu, the gastric tube liquid from the 2:00 AM aspiration is clear; the coffee-ground color is gone.”
“What's the blood pressure?”
“98/60.”
“On the low side. Add another dose of Albumin.”
“Okay.”
Lu Chen opened his eyes.
A sliver of light had already appeared in the sky outside.
The first night had passed.
There would be many more nights to come.