74: Chapter 74 You plan to perform this surgery yourself?
Lu Chen's pupils contracted slightly.
The patient's condition was far more severe than what had been handed over by the 120 ambulance.
Tension hemopneumothorax.
The amount of bleeding in the thoracic cavity was already approaching 1800 milliliters, and it was still rising.
What was more troublesome was that a thoracoplasty performed twenty years ago had left extensive adhesions in his thoracic cavity.
These adhesions had completely blocked the normal Puncture channels.
Inserting the needle in the conventional position would either pierce a blood vessel within the adhesion bands, leading to massive hemorrhage, or Puncture the adhered lung tissue, causing an even larger pneumothorax.
Coupled with the coagulation dysfunction caused by warfarin anticoagulation, once bleeding started, it would be very difficult to stop.
This patient was a ticking time bomb.
But the system had provided a way.
The sixth intercostal space, posterior to the anterior axillary line.
A three-centimeter safety window.
The depth of the tube placement should not exceed eight centimeters.
Three centimeters.
This margin for error was suffocatingly small.
When ordinary doctors perform Closed Thoracic Drainage, the Puncture window is at least five to six centimeters or more, and they don't need to consider the path of the adhesion bands.
But for this patient, there were only three centimeters.
Being off by even a little would be a disaster.
If it were any other ordinary Resident Physician, or even an ordinary attending physician performing this procedure, something would most likely go wrong.
But Lu Chen was not an ordinary person.
On his skill panel, a line of large text was written.
Closed Thoracic Drainage.
perfect level.
"Push him into the Resuscitation Room!"
Lu Chen's voice instantly switched to work mode.
Shen Xiaoning and Meng Yan worked together to push the patient into the Red Zone Resuscitation Room.
"Open two large-bore intravenous lines! Rapid fluid resuscitation! Start with Ringer's solution!"
"Set up ECG monitoring and continuous blood oxygen monitoring!"
"Draw blood for Complete blood count, coagulation function, and blood typing and cross-matching, then send them urgently!"
"Notify the blood bank to prepare blood; prepare four units of suspended red blood cells first!"
The orders came one after another, clear, accurate, and without a second of hesitation.
Shen Xiaoning's hands were rapidly executing every instruction.
Although she was nervous inside, her hands were not shaking.
This was her first time independently assisting in such a critical resuscitation in the Red Zone.
But she knew that the person standing beside her was Lu Chen.
This realization steadied her heart.
Meng Yan was assisting quickly on the side while picking up the phone.
"I'm calling for a consultation from the Department of Thoracic Surgery!"
"Yeah, hurry." Lu Chen was performing a physical examination while closely monitoring the numbers on the monitor.
The blood pressure was still dropping.
Systolic blood pressure was at 78.
Blood oxygen was 85%.
Heart rate had spiked to 132.
The speed of mediastinal shift was faster than the system had estimated.
This patient couldn't hold on for twenty minutes.
He might not even be able to hold on for fifteen minutes.
Just then, the patient's wife rushed in.
"Doctor! Doctor, please save him! How is he doing!"
"Family member, please go out first; we are in the middle of resuscitation." Meng Yan blocked her path.
"I'm not going out! I want to watch him! Do you even know how to treat him!"
"Ma'am, being here will affect our procedure; please wait outside." Shen Xiaoning also came over to persuade her.
"I don't care! What's wrong with my husband! Say something!"
The woman's emotions had completely collapsed, and she grabbed Shen Xiaoning's arm without letting go.
Lu Chen didn't even look up.
"Ma'am, your husband has a large amount of blood and air in his left thoracic cavity, which is compressing his heart. If we don't drain and decompress it immediately, his heart will stop within fifteen minutes."
The Resuscitation Room went quiet for a second.
The woman froze.
"You, what did you say? His heart is going to stop?"
"I am stating the facts. Every second is important now; your staying here will only delay us in saving him."
Lu Chen's voice was not loud, but every word was clear.
The woman opened her mouth, but was pulled out by Meng Yan.
"Come with me outside and let the doctors save him in peace."
The door closed.
The Resuscitation Room quieted down again, leaving only the beeping of the monitor and the patient's heavy wheezing.
"What did the Department of Thoracic Surgery say?" Lu Chen asked.
Meng Yan poked her head in from outside.
"The thoracic surgeon on duty said that elective surgeries are fully booked this morning; the director and both associate directors are currently in surgery, and it will take at least forty minutes for them to come down for a consultation."
Forty minutes.
Lu Chen glanced at the monitor.
Systolic blood pressure 75.
Blood oxygen 83%.
The trachea had already started to shift to the right.
This patient couldn't wait forty minutes.
He couldn't even wait twenty minutes.
"Is Brother Wu here?"
"Wu Fan is in the lounge; I'll go call him!"
Sun Ji ran over from outside.
Two minutes later, Wu Fan arrived at the Resuscitation Room.
He glanced at the patient's condition and monitoring data, and his expression changed.
"Tension hemopneumothorax?"
"Yes, and he has a history of left thoracoplasty, with extensive adhesions in the thoracic cavity."
Wu Fan was stunned for a moment.
"Adhesions?"
"Left over from a tuberculosis surgery twenty years ago; the conventional Puncture position can't be used."
Wu Fan's expression became even uglier.
"Then we have to wait for the Department of Thoracic Surgery."
"The Department of Thoracic Surgery said at least forty minutes."
"Forty minutes? This patient..."
"Can't wait."
Wu Fan fell silent.
He had worked in the Emergency Department for so many years; how could he not see what the situation was?
The patient's vital signs were constantly dropping, and the signs of mediastinal shift were already very obvious.
If decompression and drainage weren't completed within fifteen minutes, once the heart stopped, it would be too late for everything.
But Closed Thoracic Drainage with adhesions was not just normally difficult.
If you do a blind Puncture and pierce a blood vessel inside the adhesion bands, what then?
What if you tear the adhered lung tissue?
Plus, the patient was still taking warfarin, his coagulation function was a mess, and once bleeding started, it would be impossible to stop.
"Are you planning to do it yourself?" Wu Fan stared at Lu Chen.
"Yes."
"Have you ever performed Closed Thoracic Drainage?"
"I've mastered it theoretically."
"Theoretically?" Wu Fan's voice rose. "This isn't just ordinary thoracic drainage; this involves adhesions. Do you know what it feels like to Puncture into a thoracic cavity with adhesions?"
"I know."
"How do you know? You haven't done it!"
Lu Chen did not refute.
He had indeed never actually done it.
But he had a perfect level skill.
His hands knew what to do.
"Brother Wu, this patient has no time left."
Wu Fan looked at the monitor.
Systolic blood pressure 72.
Blood oxygen 81%.
He gritted his teeth.
"I'll call Sister Zhao."
"It's too late. She is in the Yellow Zone dealing with severe pancreatitis; it will take at least ten minutes for her to get here, and this patient can't afford to wait."
"Then call Director Li!"
"Director Li is at an off-site meeting this morning and is not in the hospital."
Sweat broke out on Wu Fan's forehead.
It wasn't that he didn't trust Lu Chen's skills.
He had seen everything this kid had done during this time—Suturing, intubation, diagnosis, everything was top-notch.
But Closed Thoracic Drainage was different.
Especially in complex cases like this with extensive adhesions, only a few people in the entire hospital could do it independently, all of whom were big shots in the Department of Thoracic Surgery.
A Resident Physician, in the Emergency Department's Resuscitation Room, with the most rudimentary conditions, performing this level of procedure...
"Brother Wu."
Lu Chen's voice interrupted his thoughts.
"If I don't do it, he will die."
Wu Fan looked into Lu Chen's eyes.
Those eyes were very calm.
It was not the calmness of the ignorant and fearless.
It was the calmness of having absolute certainty.
Wu Fan had seen this look many times before.
Every time, Lu Chen had proven that his judgment was correct with the results.
"Are you sure?"
"Yes."
"How sure are you?"
"Enough."
Wu Fan took a deep breath.
"I'll be your First assistant. Although I haven't done drainage with adhesions, I can handle the basic assistance."
"Okay."
"Also, you need to get the family member to sign."
Lu Chen nodded.
"Sister Meng, call the family member in."