194: Chapter 194: Last Place Elimination - Lowest Score Receives Direct Homecoming
The day of the competition, 7:00 AM.
Lu Chen got up half an hour earlier than usual.
When he finished washing up and stepped out, there were already several trainees moving about in the hallway.
The atmosphere was clearly different from the previous few days.
Some were whispering about scenario predictions, while others were doing finger dexterity warm-ups in the hallway.
After all, there was bottom-ranking elimination today.
The person with the lowest score in the losing group would be sent home directly.
The pressure was not small.
At breakfast, the four members of Group A1 sat together.
Liu Dong didn't eat much; he was a bit nervous.
Fang Yuhang was the same as usual, leisurely gnawing on a steamed bun.
Zhou Haoran was flipping through the emergency operation flowcharts on his phone while eating.
Lu Chen ate three eggs, a bowl of porridge, and a meat bun.
"Are you nervous?"
He glanced at Liu Dong.
"A little."
"That's normal. Once you're on the field, you won't be nervous anymore."
"Aren't you nervous?"
"Not nervous."
"Is there ever a time when you're nervous?"
Zhou Haoran interjected.
"You can't tell when he's nervous."
"That's not being 'not nervous'; that's called acting well."
Lu Chen ignored them.
He put down his bowl and chopsticks and took out his phone to take a look.
Shen Xiaoning's message had arrived.
[Xiao Ning: Good luck today!!! You guys will definitely win!!]
[Xiao Ning: I'm cheering you on from Jiangcheng! Even though you can't see it, mental support is invincible!]
[Lu Chen: Received.]
[Xiao Ning: Just two words?!]
[Lu Chen: Received, thank you.]
[Xiao Ning: Fine, one more word, that's progress.]
...
8:30 AM.
All trainees gathered at the Emergency Simulation Center.
The Emergency Simulation Center was on the first floor of Building C at the training base, covering an area of over four hundred square meters.
The space was divided into two perfectly symmetrical simulated Emergency Department areas, separated in the middle by a transparent glass partition.
Each area was equipped with complete emergency equipment, including defibrillators, ventilators, chest drainage devices, surgical instrument carts, simulated medicine cabinets, etc.
Each area had three high-fidelity manikins.
The three manikins represented three patients with different injuries.
The purpose of the glass partition was very clear.
To allow the two opposing groups to see each other's operations.
This wasn't for show.
It was to create pressure.
When you are treating your patient, you can see what the team opposite is doing out of the corner of your eye; this kind of psychological pressure exists in real environments.
Instructor Han Zhiguo stood on the observation platform between the two areas.
Sitting next to him were four expert judges: Professor Yu, Professor Luo Zhenyu, Instructor Sun Gubei, and an Emergency Department surgery professor invited from 301 Hospital.
"Today's rules are very simple."
Instructor Han Zhiguo spoke.
"The two opposing groups start and end simultaneously."
"Scenario setting: An explosion accident occurred in a suburban chemical zone. There is a large amount of chemical leakage at the scene. The three casualties sent in are: severe chemical burns combined with inhalation injury, multiple fractures combined with hemorrhagic shock, and chemical poisoning combined with multiple organ dysfunction."
"Each casualty's condition will change in real-time based on your treatment methods. The manikins' programs have embedded sudden deterioration events, with timing and types triggered randomly."
"What you need to do is keep all patients alive as much as possible within the limited forty-five minutes, while ensuring the standardization of SOP execution and the fluency of team collaboration."
"There is one thing that needs to be made clear in advance."
Instructor Han Zhiguo's tone intensified.
"Today's scoring includes a stress index. We will use wearable devices to monitor each trainee's heart rate fluctuation and hand tremor amplitude in real-time."
"This data will not be directly counted into the total score, but it will serve as a reference for the experts. If total scores are close, trainees with better stress index rankings will be placed higher."
"Simply put, the calmer you are, the higher your score."
He scanned the two groups.
"Group A1 and Group B1, there will be a thirty-second preparation period after the test starts. After thirty seconds, the first batch of casualties will arrive."
"Take your positions."
Lu Chen led his three teammates into the simulation area on the left.
Through the glass, Chen Hao led his three teammates into the right side.
The two groups faced each other, with only a transparent glass partition in between.
Chen Hao's gaze swept over from across the glass, and it met Lu Chen's gaze perfectly.
The two of them looked at each other.
Neither spoke.
Neither had any unnecessary expression.
That silent competition was more intense than any words.
"Raise your hands to signal when your group has confirmed you are ready."
Lu Chen looked back at his three teammates.
Zhou Haoran stood on his right, his expression serious but his eyes steady.
Liu Dong was on the left, took a deep breath, and nodded.
Fang Yuhang was at the back, already holding the monitoring equipment and recording board in his hands.
"Ready."
Lu Chen raised his hand.
Across the glass, Chen Hao also raised his hand.
Instructor Han Zhiguo glanced at the timer.
"Thirty-second countdown."
The thirty-second preparation period.
Lu Chen quickly checked the equipment on the operation table.
Defibrillator, ready.
Ventilator, ready.
Chest drainage device, ready.
Medicine cart, ready.
Surgical instrument kit, ready.
All in place.
He stood in his position.
Took a deep breath.
Exhaled.
"Ten seconds."
"Five seconds."
"Start!"
Following Instructor Han Zhiguo's command, the doors on both sides opened simultaneously.
Three gurneys carrying simulated casualties were pushed in by the escorts.
Fang Yuhang went up to meet them immediately.
Following the triage plan discussed the night before, he completed the initial classification of the three casualties in less than eight seconds.
"Number one is red: severe chemical burns combined with inhalation injury, difficulty breathing, blood oxygen dropping. Push to Lu Chen!"
"Number two is yellow: multiple fractures combined with hemorrhagic shock, consciousness blurred, pulse weak. Push to Zhou Haoran!"
"Number three is yellow-green: chemical poisoning, vital signs temporarily okay but showing signs of deterioration. Push to Liu Dong for initial treatment!"
Triage complete.
The three gurneys reached three treatment stations respectively.
Lu Chen took over the first casualty.
The manikin's setting information popped up on the screen at the head of the bed.
Male, 38 years old. Splashed all over with highly corrosive chemicals during a chemical plant explosion. Deep chemical burns on the face and both upper limbs, approximately 35% TBSA. Simultaneously inhaled toxic fumes, causing severe edema of the upper airway mucosa.
Current status: GCS 10, blood pressure [unspecified] mmHg, heart rate 128 bpm, respiratory rate 36 bpm, blood oxygen 82%.
This casualty's core threat is the airway; inhalation injury causes progressive worsening of upper airway edema.
If an airway is not established quickly, the patient will die of asphyxiation within ten minutes.
Lu Chen did not hesitate.
"Zhou Haoran, how is the situation on your side?"
"Casualty number two has a left femoral shaft fracture combined with pelvic instability, external rotation deformity of both lower limbs, and active bleeding. I am applying pressure bandaging and initial fixation."
"What is the blood pressure?"
"78/42, heart rate 146, need emergency volume expansion."
"Fang Yuhang, open two large-bore intravenous lines for casualty number two, rapid infusion of normal saline, contact blood bank for cross-matching, prepare for whole blood transfusion."
"Received!"
Fang Yuhang immediately turned to operate.
Lu Chen's gaze returned to the first casualty.
He picked up the laryngoscope and checked the condition of the mouth and pharynx.
The upper airway mucosa was severely edematous, and the glottis was swollen so much that only a very narrow slit remained.
It was very similar to the scenario in the ninth level of the Airway Challenge.
But this time it was more complex because the casualty had large-area chemical burns on the face, the perioral tissue was deformed, and mouth opening was further limited.
Lu Chen quickly went through the plan in his mind.
Direct oral intubation: the glottis slit is too narrow; there is a risk of tearing if forced.
Nasal intubation: facial burns might mean edema in the nasal cavity as well.
fiberoptic bronchoscope guidance is the safest, but it takes a little longer.
He chose fiberoptic bronchoscope guidance with small-tube intubation.
This was the optimal plan verified during the Airway Challenge.
Changed to a 4.5 tube.
The fiberoptic bronchoscope entered the oral cavity.
The endoscopic view was displayed in real-time on the small screen.
The screen was filled with edematous mucosa and exudate.
The position of the glottis was not easy to find.
Lu Chen's hand was so steady that there wasn't a single tremor.
The tip of the fiberoptic bronchoscope moved flexibly between the edematous tissues, with every turn precise to the millimeter level.
Twelve seconds later, the glottis appeared in the camera view.
A slit of less than three millimeters.
Lu Chen did not hesitate at all.
The tip of the fiberoptic bronchoscope slid into the glottis with that extremely precise force and angle.
The tube followed.
The glottal mucosa was slightly pushed open, and the tip of the tube rotated through the narrowest section.
The cuff was inflated.
The ventilator was connected.
Blood oxygen began to rise.
"Airway for casualty number one established, ventilator ventilation started, blood oxygen rising from 82%."
The whole process took twenty-eight seconds.