165: Chapter 165 Qin Yi? Ask him for help?
7:15 PM.
A new trauma patient arrived in the Red Zone. He had scraped his thigh on a construction site rebar; the wound wasn't deep, but it covered a large area and required Debridement and Suturing.
Lu Chen had just finished the procedure and was writing the medical records when his internal line rang.
He picked it up.
"Emergency Red Zone, Lu Chen speaking."
A slightly hurried female voice came from the other end.
"Hello, Dr. Lu. This is Xiao Zhou from the Operating Room Nurse station. Deputy Director Qin from Operating Room No. 5 asked me to make this call. He wants to know if you're free to come over and help?"
Qin Yi?
That Deputy Director from the General Surgery Department?
Lu Chen frowned slightly.
"What's the situation?"
"It's an emergency surgery for an abdominal stab wound. After opening the abdomen, they found the situation is more complex than the preoperative assessment. There's vascular damage. Deputy Director Qin said he wants you to come take a look."
Lu Chen thought for a moment.
"Vascular damage? Which vessel?"
"I'm not sure about the specifics. Deputy Director Qin just said for you to come take a look."
"Alright, I'll be there in ten minutes."
He hung up the phone.
Lu Chen stood up and walked quickly over to Meng Yan.
"Sister Meng, the Operating Room called for me to help. I might have to scrub in. Please let Wu Fan know about the Red Zone shift."
"What kind of surgery?"
"Abdominal stab wound. They said there's vascular damage."
Meng Yan nodded.
"Okay, go ahead. Wu Fan and Sun Ji are holding down the fort here in the Red Zone, so it's no problem."
Lu Chen turned and walked out.
As he reached the entrance of the Red Zone, he happened to run into Shen Xiaoning walking over from the Yellow Zone.
She was holding a clean white lab coat; she was likely looking for someone.
"Dr. Lu, where are you going?"
"The Operating Room. There's a surgery that needs help."
Shen Xiaoning was stunned for a moment.
"What kind of surgery?"
"Abdominal stab wound. The specifics aren't clear yet."
Shen Xiaoning immediately set the lab coat aside.
"I'll go with you."
"Aren't you off the clock?"
"It's not time to clock out yet. I just came back early to grab some things."
The excuse was a bit forced, but Lu Chen didn't say much.
"Then let's go."
The two of them walked quickly toward the Operating Room.
In the elevator, Shen Xiaoning asked a question.
"Isn't Deputy Director Qin from General Surgery? Why is he looking for you for his surgery?"
"He said there's vascular damage. He likely needs help with the blood vessels."
Shen Xiaoning remembered the vascular anastomosis during the Liver transplantation surgery that day.
"Then it must be because no one else can handle it that he's looking for you."
Lu Chen didn't respond.
He didn't like to jump to conclusions before seeing the actual situation.
...
Outside Operating Room No. 5.
When Lu Chen and Shen Xiaoning finished changing into surgical scrubs and walked in wearing their caps and masks, the first thing they saw was the opened abdomen on the operating table.
The abdominal cavity had been completely exposed, and there was a large amount of blood and gauze in the surgical field.
Three people stood under the shadowless lamp.
Qin Yi was in the lead surgeon's position, wearing magnifying loupes and holding a long curved clamp. Sweat was trickling down from his eyebrows.
Standing in the first assistant position was a young Attending Physician from General Surgery whom Lu Chen hadn't met before.
The circulating Nurse was passing instruments nearby, and several used hemostatic clamps were piled on the table.
The anesthesiologist sat at the head of the table; the numbers on the monitor didn't look good.
Heart rate 112, blood pressure 91/58.
It was on the low side.
When Qin Yi looked up and saw Lu Chen, a clear look of relief appeared in his eyes.
"You're here. Quick, come over."
Lu Chen walked to the side of the operating table and first looked at the surgical field.
The patient was a male around thirty years old with a penetrating stab wound on the left side of his abdomen. From the outside, the wound didn't look large, but after entering the abdominal cavity, the tip of the blade had taken a very tricky angle.
"What's the situation?"
Qin Yi spoke briefly.
"An abdominal stab wound sent from the Emergency Department. The preoperative CT assessment was a Splenic Laceration, but after we opened him up, we found it wasn't just a problem with the spleen."
"The Splenic Laceration has been resected and hemostasis has been performed, but the vascular damage near the splenic hilum is more serious than imagined. The root of the Splenic Artery was pierced with a 1-centimeter hole."
Lu Chen's gaze fell deep into the surgical field.
Qin Yi continued.
"The problem is at this location. The root of the Splenic Artery runs closely along the upper edge of the Pancreas."
"We tried direct suture repair twice, but this position is too deep. The operating angle is extremely restricted, and the suture needle can't get in."
"During the first attempt, I almost accidentally injured the pancreatic capsule, so I stopped."
"The second time I changed the angle, but because the blood loss was so heavy, the field of vision was constantly blocked by blood. The hemostatic clamp is just a temporary solution and can't be maintained for long."
Although Qin Yi kept his voice steady, Lu Chen could tell he was speaking much faster than usual.
This indicated he was under pressure.
"See if you can handle it."
Lu Chen didn't answer immediately.
He first activated the Eye of Truth.
[Eye of Truth scan complete]
[Patient Information: Male, 31 years old]
[Chief Complaint: Penetrating abdominal stab wound causing Splenic Laceration and Splenic Artery injury]
[Eye of Truth Diagnosis: Spleen has been resected. Penetrating injury at the root of the Splenic Artery with a rupture of approximately 1.1 cm, located on the posterior wall of the initial segment of the Splenic Artery, adjacent to the upper edge of the Pancreas. Active bleeding is present in the surrounding area, currently controlled by temporary hemostatic clamping. The clamping position is about 1.5 cm from the rupture, and the estimated effective clamping time is limited.]
[Danger Level: Grade A]
[Current Symptoms: Compensated stage of hemorrhagic shock. 4 units of red blood cell suspension have been transfused. Blood pressure is barely maintained. Vascular repair needs to be completed as soon as possible to restore effective circulation.]
[Recommendation: The location of the rupture at the root of the Splenic Artery is unique, and the conventional Suturing angle is restricted. It is recommended to use an Improved Interrupted Mattress Suture Technique, utilizing the natural elasticity of the vessel wall for alignment and repair, avoiding excessive traction that could cause further tearing of the vessel wall.]
[Warning: The temporary hemostatic clamping solution cannot be maintained for long. After more than 20 minutes, the vessel wall at the clamping site will suffer irreversible damage. It has currently been clamped for approximately 14 minutes.]
14 minutes.
Only 6 minutes left.
Lu Chen looked up.
"Director Qin, I see it. The rupture is on the posterior wall of the initial segment of the Splenic Artery. The position is indeed very deep and closely adjacent to the Pancreas."
Qin Yi nodded.
"Yes, that's the position giving me a headache. The angle of conventional instruments can't reach the posterior wall."
"Can you see the edges of the rupture?"
"I can barely see a bit, but blood keeps oozing. The clamp is holding the upstream, so the oozing has decreased but hasn't completely stopped."
Lu Chen glanced at the monitor again.
Blood pressure 89/55.
It had dropped a bit more.
"Director Qin, how long has the clamp been on?"
"About fourteen or fifteen minutes."
"It can't exceed twenty minutes. Beyond that, the vessel wall at the clamping site will have problems."
Qin Yi's brow furrowed tightly.
"I know, that's why I called you."
Lu Chen looked at the surgical field again and made a quick judgment.
"I'll do the Suturing."
When those words were spoken, the air in the Operating Room seemed to go silent for a beat.
Qin Yi looked at him.
"Are you sure?"
"Yes."
Lu Chen's tone was flat but firm.
"Using an improved interrupted mattress suture, I need a Microsurgical Needle Holder, suture thread, and a fine Right-angle Clamp."
Qin Yi stared into his eyes for two seconds.
After two seconds, he stepped down from the lead surgeon's position.
"Step up."
Lu Chen took the lead surgeon's position.
Shen Xiaoning had already washed her hands and put on her surgical gown on the side, silently standing next to the scrub Nurse.
"I'll pass the instruments."
Her voice was very steady, without a hint of panic.
The circulating Nurse glanced at her, nodded, and yielded the position.
"Microsurgical Needle Holder."
Shen Xiaoning accurately picked up the needle holder from the instrument table and handed it to Lu Chen with the handle forward.
Lu Chen took it, his fingers adjusting the grip angle on the holder.
"Suture thread."
Shen Xiaoning tore open the suture packaging, threaded the needle, and handed it over.
The entire process was clean and efficient, without the slightest hesitation.