195: Chapter 195 The First Random Deterioration Event
Across the glass partition, Chen Hao was treating their Patient No. 1.
His Patient No. 1 also had airway issues, but the set conditions were slightly different.
Chen Hao took one minute and twelve seconds to complete the intubation, attempting it twice during the process.
It wasn't slow, but compared to Lu Chen's twenty-eight seconds, the gap was significant.
On the judging panel, Instructor Sun Gubei glanced at the timing data on both sides; he didn't speak but gave a slight nod.
After Lu Chen finished establishing the airway for Patient No. 1, he didn't stop.
He immediately checked the patient's facial and bilateral upper limb chemical burns.
"Liu Dong, what is the current status of Patient No. 3?"
"Patient No. 3 is temporarily stable, but the blood gas analysis shows metabolic acidosis, pH 7.24. I am administering sodium bicarbonate to correct the acidosis."
"Good, keep monitoring. If the pH continues to drop, report it to me."
"Received."
Lu Chen returned to Patient No. 1.
Chemical burns require copious irrigation with water, but in the simulated environment, this step is completed via commands.
He initiated the standard chemical burn irrigation protocol on the simulator's control panel and simultaneously issued orders for fluid resuscitation and analgesia.
Four minutes passed.
Patient No. 1's airway was stabilized, and on the side of Patient No. 2, Zhou Haoran had already completed temporary stabilization of the limb fractures and pressure hemostasis.
Fang Yuhang's monitoring data updated in real-time: Patient No. 2's blood pressure had risen back to 85/52; it was still on the low side but was not continuing to drop for the moment.
Everything was proceeding according to plan.
At the six-minute mark, a sudden incident occurred.
The simulation system triggered the first random deterioration event.
The ventilator for Patient No. 1 sounded an alarm.
"Airway pressure spike!"
Fang Yuhang was the first to shout out.
Lu Chen had already reached the side of Patient No. 1 within two seconds.
He checked the ventilator data.
The peak airway pressure had surged from 22 cmH2O to 45 cmH2O.
Blood oxygen began to drop from the recovering 94%—93, 91, 89.
"Acute exacerbation of chemical ARDS caused by inhalation injury!"
Lu Chen's assessment was completed within one second.
Chemical Acute Respiratory Distress Syndrome.
After inhaling toxic chemical fumes, chemical damage to the alveoli and bronchioles led to extensive inflammatory exudation in the lung tissue, causing a sharp decline in lung compliance.
This was the ticking time bomb buried in the scenario.
"Ventilator adjustment: increase FiO2 to 100%, raise PEEP from 5 to 12, and reduce tidal volume to 6ml/kg!"
While reciting the medical orders, Lu Chen was already adjusting the ventilator parameters.
"Fang Yuhang, administer an additional 10mg of dexamethasone via IV push to Patient No. 1, and simultaneously prepare for prone ventilation!"
"Received!"
Lu Chen's speaking pace was not fast, but his train of thought was clear, with intervals between each instruction not exceeding two seconds.
What happened next caught everyone off guard.
Less than thirty seconds after Lu Chen finished adjusting the ventilator parameters for Patient No. 1, the simulation system triggered a second deterioration event.
Percussion of Patient No. 1's left thorax changed to hyper-resonance.
Breath sounds disappeared.
"Pneumothorax!"
Lu Chen narrowed his eyes.
ARDS combined with pneumothorax.
This wasn't a mere coincidence; it was a double blow intentionally designed by the simulation system.
Under high PEEP ventilation conditions, chemically damaged lung tissue is highly susceptible to barotrauma, leading to pneumothorax.
This was the side effect of him setting the PEEP to 12 just moments ago.
But if he hadn't adjusted the PEEP, the blood oxygen would have plummeted to lethal levels.
This was a dilemma, a trap.
And Lu Chen had made all the assessments within three seconds.
"Left-sided tension pneumothorax, immediate needle decompression required!"
"Zhou Haoran, can you step away from your station?"
"Yes, Patient No. 2 is temporarily stable."
"Come over and help me hold the simulator's left arm, keep it in an abducted position."
Zhou Haoran rushed over in two steps and held down the simulator's left arm.
Lu Chen grabbed a chest puncture needle from the instrument cart.
Second intercostal space, left mid-clavicular line.
Needle insertion.
The moment the needle tip penetrated the chest wall, the simulation system emitted a "hiss" sound effect of gas release.
Tension pneumothorax decompression successful.
"Switch to a Closed Thoracic Drainage tube; insert the drain at the fifth intercostal space, mid-axillary line."
Lu Chen put down the puncture needle and switched to the drainage tube.
Skin incision, blunt dissection, digital exploration of the thoracic cavity, and insertion of the drainage tube.
Connect to the water-seal bottle.
The entire process took one minute and four seconds.
After the drainage tube was connected, bubbles continuously escaped from the water-seal bottle, indicating that the pneumothorax gas was being effectively drained.
Patient No. 1's blood oxygen began to rise.
89, 91, 93, 95.
Stabilized.
Lu Chen stood up straight and quickly scanned the situation of the entire field.
Patient No. 2 was temporarily stable under Zhou Haoran's care.
Patient No. 3's pH had returned to 7.28 under Liu Dong's monitoring and showed a trend of improvement.
Fang Yuhang shuttled between the various monitors, recording every bit of data without omission.
"Fang Yuhang, report the current vital signs of all patients."
"Patient No. 1: blood oxygen 95 and rising, heart rate 118, blood pressure 92/58."
"Patient No. 2: blood pressure 88/55, heart rate 136, GCS score 9."
"Patient No. 3: blood pressure 105/70, heart rate 98, blood oxygen 97."
"Received."
Lu Chen quickly performed an overall assessment in his mind.
Patient No. 1 is currently the most critical but has stabilized; follow-up monitoring of the pneumothorax drainage and ARDS progression is needed.
Although the bleeding for Patient No. 2 is temporarily controlled, the hidden hemorrhage from the pelvic fracture could erupt again at any moment.
Patient No. 3's chemical poisoning requires continuous detoxification treatment.
Thirteen minutes had passed.
The rhythm under high pressure was controlled seamlessly by Lu Chen.
On the observation platform, Instructor Sun Gubei said in a low voice to Professor Luo Zhenyu beside him.
"His team coordination ability surprises me even more than his individual operational skills."
Professor Luo Zhenyu pushed up his glasses.
"It's not just the coordination; did you notice his instruction pattern?"
"What do you mean?"
"From beginning to end, he hasn't said a single ambiguous instruction."
"Every order has a clear recipient, a clear action, and a clear standard of completion."
"This type of instruction format is only mandatory in military emergency training."
"As a Resident Physician in a local Hospital, he developed this habit on his own."
Instructor Sun Gubei was silent for a moment.
Then he turned his head to look at Group B1 across the glass.
The situation on Chen Hao's side was not as smooth.
The initial treatment by Group B1 was actually not slow.
Chen Hao's individual operational ability was indeed very strong; although he was a bit slower with Patient No. 1's airway, he still completed it within a reasonable time.
The problem lay in team coordination.
When their Patient No. 1 also triggered the double blow of ARDS combined with pneumothorax, Chen Hao's reaction was indeed fast, and he also determined that the tension pneumothorax required immediate decompression.
But he ran into problems when issuing the instructions.
He shouted, "It's a pneumothorax, perform a puncture quickly."
But he didn't specify who should do it.
Li Minghui and the Attending Physician from Lanzhou moved at the same time.
The two nearly collided.
"I'll do it."
"I'll do it."
Three seconds of hesitation and conflict.
In a real emergency, three seconds could be the line between life and death.
In the end, Chen Hao performed the puncture decompression himself.
But this three-second chaos was seen clearly by the judging experts.
An even bigger problem occurred with Patient No. 2.
Group B1's Patient No. 2 had multiple fractures complicated by hemorrhagic shock, and the initial treatment was similar to that of Zhou Haoran in Group A1.
But around the twenty-minute mark in the middle stage, the simulation system triggered another random deterioration event.
Patient No. 2's blood pressure suddenly plummeted from 85/50 to 60/35.
The reason was that the retroperitoneal hemorrhage from the pelvic fracture had suddenly worsened.
The Associate Chief Physician from Tianjin was responsible for this patient.
His first reaction was to accelerate blood transfusion and fluid infusion.
But this assessment was not enough.
Simple volume replacement has limited effect when facing active retroperitoneal hemorrhage.
What was needed was external pelvic fixation combined with pressure hemostasis, or emergency interventional embolization.
But in the simulated environment, interventional equipment was unavailable, so they had to rely on physical means.
The Associate Chief Physician from Tianjin hesitated.
He wasn't sure if he should perform the external pelvic fixation himself or wait for Chen Hao to decide.
He looked back at Chen Hao.
Chen Hao was busy dealing with the follow-up for Patient No. 1's pneumothorax.
He was busy.