97: Chapter 97 predicts cardiac arrest will occur within 3 minutes!
"What is going on!" Zhao Yaqin's voice suddenly became tense.
Director Li Sen's expression also changed.
He had clearly just drained 250 milliliters of fluid, and the patient's condition had been improving.
Why had it suddenly deteriorated again?
Lu Chen's gaze was fixed intently on the ultrasound screen.
He saw the reason.
The loculated cavity on the left side was expanding rapidly.
Because the pressure in the main cavity had suddenly dropped, the balance that had been maintained was broken.
The fluid in the loculated cavity did not decrease; instead, due to the change in the pressure gradient, it began to accelerate its pressure against the left ventricular lateral wall.
And even worse, there appeared to be a tiny leak in the adhesion band between the loculated cavity and the main cavity.
It wasn't fluid flowing from the loculated cavity into the main cavity.
Rather, the negative pressure created after draining the main cavity was sucking in the exudate from the surrounding tissue.
The loculated cavity was being passively filled.
[Eye of Truth Emergency Warning!]
[The left loculated effusion cavity is expanding rapidly; the current estimated effusion volume has reached 350ml!]
[The left ventricular lateral wall is under severe pressure; cardiac output is plummeting!]
[Danger level has been raised to SS level!]
[Cardiac arrest expected within 3 minutes!]
[Recommendation: Perform independent Puncture and drainage of the left loculated effusion cavity immediately!]
Three minutes.
Lu Chen's breathing skipped a beat.
"Director Li!"
His voice suddenly rose an octave.
Everyone in the Resuscitation Room turned to look at him.
"There is a loculated cavity on the left that is not connected to the main cavity. Look at the screen!"
Li Sen immediately turned to look at the ultrasound screen.
Lu Chen quickly moved the probe, switching to a left parasternal view.
On the screen, the loculated cavity was clearly displayed.
An independent effusion cavity surrounded by adhesion bands.
It was pressed right against the left ventricular lateral wall.
And it was visibly expanding.
"The effusion in this cavity was not drained. After the main cavity was decompressed, the pressure difference changed. The pressure in the loculated cavity is actually rising, and it is compressing the left ventricle!"
Li Sen's pupils contracted sharply.
In an instant, he understood what had happened.
This was one of the most dangerous complications in Pericardiocentesis.
Imbalanced drainage of loculated pericardial effusion.
You drain the fluid from one cavity, but the pressure in the other cavity rises because the original pressure balance between the two cavities was broken.
"We need to perform an independent Puncture on the loculated cavity," Lu Chen said.
Li Sen looked at the image on the screen, his expression unprecedentedly grave.
He could see where the loculated cavity was located.
The left ventricular lateral wall.
To perform a Puncture at this location, the needle must be inserted near the apex of the heart.
And the difficulty of apical Puncture is far higher than subxiphoid Puncture.
Because the needle path must pass through the edge of the lung tissue; the slightest carelessness could pierce the lung, causing a pneumothorax.
Even more fatal was that the loculated cavity was wrapped in adhesion bands, making the window for a safe Puncture even smaller.
And now, there were only three minutes left.
No, it was already less than three minutes.
The heart rate on the monitor had soared to 160.
Blood pressure continued to drop.
60/38.
The patient began to become restless.
"My chest feels so tight, I can't stand it..."
"Director Li." Zhao Yaqin's voice was strained. "The blood pressure is still dropping."
Li Sen's hand holding the Puncture needle paused for a moment.
He was assessing the situation.
Inserting a needle from the apex to Puncture the loculated cavity required extremely precise ultrasound guidance and an extremely steady hand.
The needle path contained lung tissue, adhesion bands, and the left ventricular wall.
A difference of one millimeter could be fatal.
He could perform this procedure.
But he was not entirely certain of success.
In his twenty-plus years of practicing medicine, he had only performed apical Punctures for loculated pericardial effusion twice.
Both times were successful.
But the conditions those two times were much better than now; there were no adhesions, and the fluid distribution was not this complex.
A two-second hesitation.
In the Emergency Department, a two-second hesitation could sometimes be the difference between life and death.
"Director Li."
Lu Chen's voice rang out at this moment.
It was very calm.
No tension, no impatience.
"I will do it."
Li Sen turned to look at him.
The gazes of everyone in the Resuscitation Room were focused on Lu Chen.
"You?" Zhao Yaqin blurted out.
"I will perform the Puncture on the loculated cavity. Director Li, maintain the current drainage of the main cavity; do not remove the needle."
Li Sen stared into his eyes.
In those young eyes, he saw no hesitation or bluffing.
Only absolute composure.
"Are you confident?"
"Yes."
One word.
No explanation, no preamble.
Li Sen made a decision.
"Proceed."
Lu Chen made no unnecessary movements.
He handed the ultrasound probe to Zhao Yaqin.
"Sister Zhao, please help Director Li maintain the ultrasound monitoring of the main cavity."
Then he walked to the equipment table and picked up the second Puncture kit.
Shen Xiaoning had already torn open the sterile packaging in advance.
Her hands were also trembling slightly, but her movements were flawless.
Lu Chen put on sterile gloves and took out the Puncture needle.
Then he picked up the second ultrasound probe from the equipment table.
The portable ultrasound device had a dual-probe interface, which could output two images simultaneously.
"Shen Xiaoning, switch the screen to split-screen mode."
"Okay!"
Shen Xiaoning operated quickly; the left side of the screen displayed the image of the main cavity from Li Sen's side, while the right side switched to Lu Chen's probe view.
Lu Chen placed the probe near the apical impulse area on the patient's left chest wall.
He adjusted the angle.
The Master Level Ultrasound-Guided Puncture skill was fully activated at this moment.
Although this was his first time using this skill in actual combat, all the knowledge, experience, and tactile feel regarding Ultrasound-Guided Puncture in his mind were incredibly clear at this moment.
The angle of the probe, the adjustment of the frequency, the setting of the gain.
The image changed frame by frame on the screen.
He was looking for that window.
The loculated cavity next to the left ventricular lateral wall.
Surrounded by adhesion bands.
In front was the lower edge of the lung tissue.
He needed to find a channel not covered by lung tissue, where there was a gap between the adhesion bands, that could safely reach the loculated cavity.
One second.
Two seconds.
Three seconds.
Found it.
About one centimeter lateral to the apex, in the fifth intercostal space.
There was a window.
The lung tissue would periodically move away during respiratory movement; at the end of expiration, the diameter of this window was about 1.8 centimeters.
There were no adhesion bands blocking the channel.
Direct access to the loculated cavity.
But this window only opened completely at the end of expiration.
That is to say, he had to insert the needle at the exact moment of the patient's end-expiration, and he had to get it right in one go.
Because with the next inspiration, the lung tissue would move over to cover this window.
One chance.
One needle.
"Found the Puncture window." Lu Chen's voice remained calm.
He used a marker to mark the needle insertion point on the patient's skin.
Then he quickly performed local disinfection.
"Fifth intercostal space, one centimeter lateral to the apex, insert needle at end-expiration, estimated depth 3.5 centimeters."
He reported these data.
It wasn't for anyone else to hear.
It was to confirm his own operational parameters.
Li Sen was maintaining the drainage needle for the main cavity on the other side, while watching Lu Chen's movements out of the corner of his eye.
He said nothing.
Because he knew that at this time, any superfluous words would interfere with the operator's concentration.
The numbers on the monitor were still deteriorating.
Heart rate 168.
Blood pressure 55/32.
Blood oxygen 87%.
The patient had already begun to lose consciousness.
Time was running out.
Lu Chen held the needle in his right hand and fixed the ultrasound probe with his left.
His hands were abnormally steady.
Not a single tremor.
This was the permanent effect of the achievement [newcomer: surgical blade].
Hand stability increased by 10%.
Plus the physical fitness bonus from the genetic enhancement serum.
And the inherent skill stability of Master Level Ultrasound-Guided Puncture.
A triple superposition.
He was waiting.
Waiting for the patient's respiratory cycle.