190: Chapter 190 is the best result in the history of the training program.

Lu Chen guided the tip of the fiberoptic bronchoscope directly above the glottis.

He could see that extremely narrow gap.

Then, he began to advance the scope.

The tip of the fiberoptic bronchoscope slid into that gap with an almost imperceptible force—gently, slowly, and precisely.

The edematous glottic mucosa was slightly stretched by less than a millimeter.

There was no tearing.

There was no bleeding.

The fiberoptic bronchoscope passed through the glottis.

The tube followed along the guidance of the fiberoptic bronchoscope.

This step was more difficult because the diameter of the tube was thicker than the fiberoptic bronchoscope.

Lu Chen's right hand applied an extremely precise rotational force to the end of the tube.

The tip of the tube performed a thirty-degree spin within the glottis.

With just this single rotation, the bevel of the tube's tip passed through the narrowest cross-section of the glottis during the spin.

It went in.

The tube successfully reached inside the trachea.

The cuff was inflated.

Auscultation confirmed placement.

54 seconds.

Zhou Haoran clutched his head with both hands.

"This is not an operation a human could perform."

His voice wasn't loud, but the few students nearby heard it.

No one refuted it.

Because everyone had the same thought in their hearts.

Instructor Sun Gubei walked over to the mannequin and picked up the fiberoptic bronchoscope to re-examine the state of the glottis.

The mucosa was intact.

There was no tearing or bleeding whatsoever.

He put down the fiberoptic bronchoscope and stood there in silence for about five seconds.

Then he turned his head to look at Lu Chen.

"Ninth stage, pass."

When these three words were spoken, his tone was different from the previous eight stages.

Before, it was a professional announcement.

In the word "pass" for the ninth stage, there was a sense of confirmation and approval.

...

Tenth stage.

Instructor Sun Gubei spent nearly two minutes setting the parameters.

When he turned around, his expression was very serious.

"The scenario for the tenth stage is adapted from a real case I encountered during a military exercise two years ago."

"There were four military doctors present at the time, and it was only solved after I performed the operation myself."

"The scenario is as follows: a patient with blast injuries, cervical spine injury stabilized; severe facial trauma makes oral intubation impossible; inhalation injury complicated by tracheal collapse below the glottis; after nasal intubation, the tube cannot be advanced to the ideal depth."

"At the same time the tube advancement is blocked, the patient suddenly suffers cardiac arrest."

"You need to initiate Cardiopulmonary resuscitation while maintaining the intubation, and complete the final positioning of the tube during the CPR process."

"At the same time, provide a follow-up treatment plan."

"Time limit: three minutes."

The entire room was silent.

This was no longer simple airway management.

This was an extreme three-in-one assessment of airway management, Cardiopulmonary resuscitation, and on-the-spot decision-making.

Lu Chen glanced at the mannequin's parameter settings.

Then he nodded.

"Start."

Instructor Sun Gubei pressed the timer.

Lu Chen inserted the tube through the right nasal cavity.

The tube passed through the nasopharynx into the oropharynx, and then through the glottis.

But at a position about three centimeters below the glottis, the tube could not be pushed further.

Tracheal collapse.

At this moment, the mannequin's Electrocardiogram monitor suddenly displayed a ventricular fibrillation waveform.

"Ventricular fibrillation!"

Lu Chen did not panic.

His right hand maintained the tube's position, neither pushing nor pulling.

His left hand immediately picked up the defibrillation pads and quickly applied them to the mannequin's chest wall.

"Charging 200 Joules!"

He called out the instructions, his hands moving without any hesitation.

Defibrillation complete.

The mannequin's heart rhythm converted to pulseless electrical activity.

"1mg Epinephrine, IV push!"

At the same time Lu Chen finished saying this, his right hand performed an extremely precise movement at the end of the tube.

He slowly withdrew the tube by half a centimeter, and then, during the interval of the mannequin's autonomous chest movement, used a very gentle rotational advance to push the tip of the tube past the collapsed segment.

The window of opportunity for this operation was less than two seconds.

The tube passed through.

It reached the ideal depth.

The cuff was inflated.

Lu Chen connected the bag valve mask and began ventilation in sync with the CPR frequency.

At the same time, he didn't stop talking.

"Check rhythm."

The mannequin's Electrocardiogram was still showing pulseless electrical activity.

"Continue chest compressions, Epinephrine every three minutes. Consider the possibility of tension pneumothorax exacerbating the cardiac arrest; emergency assessment of bilateral chest symmetry is required."

While performing compressions, he continued to report his plan.

"If tension pneumothorax is confirmed, perform needle decompression immediately."

"At the same time, prepare to establish a second intravenous access for sodium bicarbonate to correct acidosis."

"For follow-up management of the tracheal collapse, it is recommended to perform a bronchoscopy to assess the degree of tracheal stenosis as soon as circulation is restored, and place a tracheal stent if necessary."

His speaking speed was not fast, but every sentence precisely hit the most critical points of clinical decision-making.

No wasted words.

No hesitation.

Every medical order had clear conditional judgment and timing for execution.

Instructor Sun Gubei listened from the side, one hand unconsciously gripping the other.

One minute and forty-seven seconds.

Lu Chen finished all operations and the case report.

He took a step back.

The number lit up on the timer was 1 minute and 47 seconds.

The limit was three minutes.

He used less than two minutes.

The simulation room was quiet for at least ten seconds.

Then Instructor Sun Gubei spoke.

"Tenth stage."

His voice sank slightly.

"Pass."

After saying the two words, he did not leave.

He stood there looking at Lu Chen, silent for a few seconds.

Then he walked back to the podium at the front.

"Today's challenge assessment is over."

He faced the fifty students.

"Out of fifty people in the room, eighteen reached above the fifth stage, five reached above the seventh stage, and one reached above the eighth stage."

"Only one person passed all ten stages."

He looked at Lu Chen.

"Number 49, Lu Chen, Jiangcheng City Central Hospital, Emergency Department, Resident Physician."

"Passed all ten stages on the first attempt, zero errors, total time elapsed was four minutes and thirty-two seconds."

"The operation time for each stage was more than fifty percent below the standard time limit."

He paused.

"This result is the best in the history of this training program since its inception."

The best in history.

These four words slammed into the ears of everyone present.

Previously, Professor Yu said in the anatomy class that he was the "fourth textbook-level student in twelve sessions."

Now, Instructor Sun Gubei said he was the "best in history."

Not one of.

But the only one.

Someone in the classroom started clapping.

Then the applause merged into a wave.

Zhou Haoran clapped the hardest.

Chen Hao stood in the back, arms crossed over his chest, not clapping.

There was no obvious expression on his face.

But his gaze was fixed on Lu Chen, never looking away.

Instructor Sun Gubei continued.

"I want to specifically mention the ninth and tenth stages."

"The two-millimeter glottis traversal in the ninth stage has a success rate of no more than five percent in real clinical practice."

"As for the synchronous treatment of airway management combined with cardiac arrest in the tenth stage, I have seen no more than three people who could complete it during military exercises."

"Neither of these two stages was in the original assessment standards; I added them extra."

"Originally, I expected that if someone could reach the eighth stage, I would already be very satisfied."

"You passed ten stages."

"And your operations were not just successful; every one of your actions had a clear reason."

"In the tenth stage, you maintained the airway, performed CPR, and reported the plan simultaneously—three lines running in parallel, with zero confusion."

"How many years of clinical experience do you have?"

"Three months."

Instructor Sun Gubei looked at him for five seconds.

Then he snorted through his nose.

"To achieve this level in three months, I don't believe it."

"But I have to believe it."

"Because you did it right before my eyes."

He put away his lesson plan.

"Today's class is over. Take the afternoon off, and we will continue tomorrow morning."

"Dismissed."