83: Chapter 83 Danger Level: S (Extremely Critical)

Tendon rupture, metacarpal fracture, arterial bleeding.

This needs to go into the Operating Room.

"Shen Xiaoning, help me apply pressure to stop the bleeding first!"

Lu Chen used sterile gauze to pack the site of the most severe bleeding, then applied a pressure bandage.

The rate of bleeding slowed down significantly.

"This patient needs emergency surgery; I'm taking him into the Operating Room to handle it."

He said to Meng Yan.

Meng Yan nodded.

"You go to the Operating Room; I'll keep an eye on things here."

Lu Chen pushed the patient into the Operating Room.

Shen Xiaoning followed him in.

"Dr. Lu, can you perform this surgery by yourself?"

"Tendon anastomosis and fracture fixation are not my specialties, but I can handle the hemostasis, Debridement, and Suturing. I'll perform temporary fixation for the fracture and tendon parts, and then transfer the patient to the Department of Hand Surgery for secondary surgery."

This was the most realistic plan.

The core purpose of emergency surgery is to save life and limb, not to perform definitive repair.

First, stop the bleeding, clean the wound, and temporarily fix the ruptured structures to create conditions for subsequent specialized surgery.

After the local anesthesia took effect, Lu Chen began the procedure.

The Eye of Truth precisely marked the rupture site of the deep palmar arch artery branch; he clamped the bleeding point with hemostatic forceps and then sutured the vessel wall with fine Suturing technique.

The bleeding stopped.

Next was thorough Debridement.

He cleaned out the sand, gravel, and necrotic tissue within the wound bit by bit.

Then came the temporary treatment of the tendon.

Lu Chen used specialized tendon sutures to perform a modified Kessler Suturing on the ruptured extensor tendon. This was not a definitive repair, but a temporary fixation to prevent tendon retraction, which would make subsequent surgery more difficult.

Finally, there was the temporary fixation of the metacarpal fracture.

He used Kirschner wires for percutaneous pinning fixation to stabilize the fracture ends and prevent displacement.

The entire surgery took forty-two minutes.

The wound was clean, the hemostasis was thorough, and the Suturing was exquisite.

The moment the surgery ended, a system notification popped up.

[Ding! Emergency Operating Room task progress: 1/5]

[Calculating experience for this surgery]

[Suturing (perfect level): progress 74/100 → progress 76/100]

[Basic Surgical Operations (Master Level): progress 24/100 → progress 27/100]

[Manual Hemostasis (Master Level): progress 49/100 → progress 51/100]

[30% task bonus has taken effect]

[50% Emergency Surgery Skill Enhancement Card bonus has taken effect]

[Comprehensive experience multiplier: 1.8x]

1.8x.

Although no critical hit was triggered, the accumulated experience gain was still very impressive.

Lu Chen pushed the patient out of the Operating Room and handed him over to Meng Yan.

"What about the consultation from the Department of Hand Surgery?"

"They have been contacted, and they will be here within half an hour."

"Good. I performed temporary treatment for this patient's tendon and fracture. The Department of Hand Surgery will need to perform secondary repair surgery later. I've written the intraoperative precautions in the surgical record."

Meng Yan glanced at the surgical record.

"You wrote this so detailed? You even noted the specific method of tendon Suturing and the angle of the Kirschner wires?"

"It makes it easier for the people from the Department of Hand Surgery to take over."

Meng Yan looked at him and nodded.

"That's a good habit you have."

Lu Chen didn't have time to say more, because new casualties had arrived outside.

...

3:00 PM.

The second batch of severely injured patients rescued from the mine arrived.

The injuries of this batch of patients were significantly more severe.

They had been trapped longer, and the cases of crush injuries and hypoxia were more severe.

Zhao Yaqin's voice in front of the Triage Desk became increasingly urgent.

"This one, crush injury to both lower limbs for over three hours, myoglobin must be through the roof, Red Tag! Establish IV access immediately, alkalize the urine, and contact the Department of Nephrology!"

"This one, head trauma, deep coma, GCS score 5, Red Tag! Contact the Department of Neurosurgery!"

"This one..."

She paused.

The person being pushed in was a very old miner, around sixty years old, with a face full of mud and blood.

His clothes had already been cut open.

His abdomen was visibly distended.

There were large areas of purple-blue ecchymosis on his skin.

"Closed abdominal injury, positive peritoneal irritation signs, suspected rupture of intra-abdominal organs, Red Tag!"

After arranging the triage, Zhao Yaqin immediately ran to Lu Chen's side.

"Lu Chen, come take a look at this!"

Lu Chen walked quickly to the bedside.

The Eye of Truth activated automatically.

[Eye of Truth scan complete]

[Patient information: Male, 58 years old]

[Chief complaint: Buried by large amounts of rubble during the mine collapse, left abdomen crushed for about 2 hours, rescued 30 minutes ago]

[Eye of Truth diagnosis: Splenic rupture (Grade III, comminuted), massive intra-abdominal hemorrhage (about 1500ml), left kidney contusion, diffuse peritonitis]

[Danger Level: S (Extremely Critical)]

[Current symptoms: Blood pressure 75/45mmHg, heart rate 132 bpm, diffuse abdominal tenderness and Rebound tenderness, strongly positive shifting dullness, pale complexion, cold and clammy limbs, impaired consciousness]

[Recommendation: Immediate emergency surgery for Splenectomy and hemostasis, massive blood transfusion required, delayed surgery will lead to irreversible hemorrhagic shock]

[Warning: Patient's intra-abdominal hemorrhage is still ongoing; if surgery is not started within 30 minutes, mortality exceeds 90%]

S grade.

30 minutes.

Lu Chen's pupils contracted.

Comminuted splenic rupture; this cannot be solved by simple drainage or conservative treatment.

Must perform laparotomy, must perform Splenectomy, must stop bleeding.

He looked at Zhao Yaqin.

"Sister Zhao, this patient needs emergency exploratory laparotomy. The possibility of a comminuted splenic rupture is extremely high. There is a large amount of blood in the abdominal cavity, and the blood pressure is continuously dropping."

Zhao Yaqin's expression changed.

"Emergency laparotomy? In our Operating Room?"

"We can't wait for General Surgery. Look at his blood pressure: 75 systolic, heart rate 130, cold and clammy limbs. These are signs of early hemorrhagic shock. Any further delay and it will be irreversible decompensation."

Zhao Yaqin hesitated for a second.

Emergency exploratory laparotomy and Splenectomy are not surgeries of the same magnitude as the previous chest drainage and appendectomy.

This is a real major surgery.

"I'll call Director Li."

She picked up the phone.

She put it down after thirty seconds.

"Director Li said he will arrive in five minutes. He told you to prepare for surgery, and he will be your First assistant."

Lu Chen nodded.

"Okay, Shen Xiaoning!"

"Here!"

Shen Xiaoning ran over immediately.

"Preoperative preparation: laparotomy kit, instruments for Splenectomy, prepare a large amount of gauze and hemostatic materials. Notify the blood bank for emergency blood preparation: eight units of packed red blood cells, six units of plasma. Send over four units of red blood cells first!"

"Okay!"

Shen Xiaoning ran rapidly toward the Nurse Station.

Lu Chen began directing the transfer of the patient.

"Push him into the Operating Room! Don't disconnect the monitoring!"

Meng Yan, along with two Nurses, pushed the patient into the Operating Room.

Zhao Ming from the Department of Anesthesiology had just arrived at the Emergency Department five minutes ago to provide support, and upon hearing the news, he rushed over immediately.

"It's you again, Little Lu. What's the situation?"

"Miner, abdominal crush injury, splenic rupture, early hemorrhagic shock, emergency laparotomy."

Zhao Ming glanced at the data on the monitoring screen.

"Blood pressure 73, heart rate 135. This needs to be fast. I'll perform rapid sequence induction and intubation; you guys do the preoperative disinfection."

Lu Chen nodded.

Zhao Ming began the anesthesia procedure; rapid induction and intubation were done in one go.

Meanwhile, Lu Chen finished scrubbing, put on his surgical gown and gloves.

Director Li Sen pushed open the Operating Room door and walked in.

He had already changed into his surgical gown.

"How is the situation?"

"High possibility of comminuted splenic rupture, intra-abdominal hemorrhage over 1500ml. Preparing for exploratory laparotomy followed by Splenectomy."

Director Li Sen walked to the opposite side of the operating table.

He glanced at the patient's abdomen.

Purple-blue distension, board-like rigidity of the abdominal muscles.

"You are the primary surgeon, I am the First assistant. If there are any issues, I'll take over at any time."

"Okay."