The Enhanced Doctor-Chapter 540 Abdominal lift cardiopulmonary resuscitation
(Thanks to the super handsome uncle and book friend 20180429093627878 for their monthly ticket encouragement)
"Teacher Liu, the patient has washed his face and feet and drank two boxes of warm milk. He has now been given a sedative to help him sleep," Xu Yino came over to report.
"Alright, consider this patient a small project. Discuss and allocate your time accordingly, and keep an eye on him in the ward," said Liu Banxia.
Xu Yino nodded and scurried off.
Monitoring patients constantly isn’t an easy job; it entails more than just sitting in a room. You also have to meticulously record relevant data—that’s the real work.
He was somewhat troubled. He was supposed to give a presentation at a school tomorrow, and he wasn’t sure if he would mislead the students.
"Dr. Liu, two car accident patients will be brought over soon. They’ve both lost consciousness," a dispatch nurse called out.
"Okay, Doctor Qi, you lead this admission. Dr. Wei, you supervise," Liu Banxia ordered.
"Li Hao will take the first patient, with Huang Bo assisting. Miao Rui will take the second, with Su Wenhao assisting," Qi Wentai said.
Hearing this, the four interns quickly got into action, a touch of nervousness in their hearts. A car accident combined with unconsciousness was a major problem, far more dangerous than simple fractures.
As soon as the ambulance arrived, an emergency medical technician quickly reported, "The patient’s body temperature is extremely low, and his blood pressure is critically low. We started an IV in the ambulance, and he could go into shock at any moment."
"Follow me to Resuscitation Room One," Li Hao instructed quickly.
"The patient is a pedestrian hit by a car, with blunt head trauma and complex abdominal injuries. He lost consciousness at the scene. Blood pressure is 70/90, heart rate 110," the EMT continued.
"Resuscitation Room Two," Miao Rui said, heading towards Room Two.
Both patients were in critical condition. Seeing Wei Yuan follow Miao Rui to Resuscitation Room Two, Liu Banxia went to Resuscitation Room One.
BEEP...
As soon as he stepped in, Liu Banxia heard the continuous warning tone from the monitor.
"Cardiac arrest! One unit of adrenaline, prepare the defibrillator," Li Hao announced.
"Hold on! Change of plans!" Liu Banxia shouted, noticing the 23-degree body temperature on the monitor.
"Qi Wentai and I will insert bilateral chest tubes for warm saline lavage. Li Hao and Huang Bo, take turns performing abdominal lift CPR, at least 100 compressions per minute. Figure out for yourselves why we’re doing this," Liu Banxia ordered.
After speaking, Liu Banxia moved to the patient’s left side and began the procedure. Qi Wentai circled to the patient’s right and started inserting a tube as well.
The nurses didn’t stand idle. Liu Banxia had ordered warm saline lavage for the chest cavity, so the saline bags needed to be warmed up immediately.
Even though Li Hao and Huang Bo didn’t understand why Liu Banxia chose this complicated method over a simpler one, they had to follow his orders strictly. They both felt this was a roundabout approach; direct CPR would be much quicker. Plus, they weren’t allowed to use adrenaline or a defibrillator. How long could a human brain survive without oxygen? If they delayed any longer, the patient might genuinely have no hope left.
"Haven’t you eaten dinner? Speed up!" Liu Banxia yelled as the slightly warmed saline was being infused.
The atmosphere in the resuscitation room instantly tensed. Everyone knew Liu Banxia was angry, likely dissatisfied with their initial resuscitation attempt.
"President Liu, don’t blame them. Even I didn’t think of it at first," Qi Wentai spoke up from the side. "You two, keep your hands moving. This is a learning experience for me as well. We’ve encountered hypothermic patients before, but we all overlooked something crucial in this resuscitation.
"The patient’s low body temperature caused the cardiac arrest. If we had immediately administered adrenaline and defibrillated, not only would it have failed to restore the patient’s heartbeat, but it would have caused further harm.
"Because the patient’s body temperature is so low, the heart wouldn’t respond even if we shocked it multiple times. When blood stops circulating for too long, toxins accumulate.
"Blankets are too slow for rewarming, so President Liu chose thoracic lavage to raise the patient’s temperature more quickly. Your task is to maintain blood circulation.
"However, because this is an indirect method, blood flow will be slow, which is why President Liu urged you to speed up. President Liu, please don’t blame them; I overlooked it too."
"Keep pushing. The temperature is twenty-eight degrees Celsius now. Once it reaches thirty degrees, we can defibrillate. Prepare one unit of adrenaline and set the defibrillator to 150 joules," Liu Banxia directed.
"You’re all good kids, but sometimes you stick too rigidly to the textbooks. You were so focused on the standard cardiac arrest protocol that you forgot to consider the patient’s temperature. The temperature has reached thirty degrees. Administer adrenaline."
"On my count..."
"Clear!"
THUMP!
"Continue compressions! Charge to 200 joules!"
"Charging... Clear!"
THUMP!
"Heartbeat restored. Asystole for three minutes and thirteen seconds. Hopefully, there’s no brain damage. Continue with other examinations. He only seems to have some abrasions on his head. Dressed so lightly, he must be the driver."
After speaking, Liu Banxia stepped back from the treatment bed, leaving Li Hao and Huang Bo to complete the remaining resuscitation efforts.
DING! Emergency admission completed.
Gained 300 Experience Points, 100 Diagnosis Skill Proficiency Points, 100 Dressing Change Skill Proficiency Points, and 50 Suture Skill Proficiency Points.
Mission Rating: Perfect. Gained 500 Experience Points, 200 Diagnosis Skill Proficiency Points, 200 Dressing Change Skill Proficiency Points, 100 Suture Skill Proficiency Points, and 10 Glory Points.
Sweat poured down Li Hao’s and Huang Bo’s foreheads. It wasn’t just from the exertion of the abdominal lift CPR, nor from Liu Banxia’s reprimand, but from the lingering fear of what could have happened.
Brain hypoxia is incredibly dangerous. Successful resuscitation within three minutes usually leads to a high recovery rate with minimal to no brain damage. Between three to five minutes, the impact can be significant, causing some degree of brain damage, though recovery is still possible. Beyond eight minutes, brain damage is typically irreversible. The extent depends on the patient’s luck, or perhaps fate. If they had followed the standard resuscitation protocol, how much time would they have wasted? Definitely more than five minutes, and that’s assuming they even remembered to consider hypothermia. The most likely outcome? They would have lost the patient. All because they hadn’t considered the impact of hypothermia. Without a doubt, it would have been a medical incident. And since they were still interns, even if Doctor Qi, as their supervising physician, took primary responsibility, their careers would have suffered.
"Abrasions on the head and right cheek. Abdominal ultrasound is normal. Get a head CT," Li Hao said after a careful examination.
"Go with him. And remember, always be extra vigilant with hypothermia patients in the future. You completely forgot about that child from last time. You owe Doctor Qi a couple of pig trotters for this," Liu Banxia said.
They both nodded quickly. Never mind a couple; they’d buy him a feast! They had almost dragged Doctor Qi down with them.
"Why the bilateral chest drains?" Wang Chao asked curiously when they pushed the patient out.
"For rewarming. How’s the other patient?" Liu Banxia asked.
"He’s gone for a CT scan, then straight to the OR. There’s free fluid in the right upper quadrant, likely a splenic rupture, but it doesn’t seem too severe. We still need to check for intracranial injuries. Brother Wei is with him," Wang Chao said.
"Officer, what happened here?" Liu Banxia asked a police officer who had just arrived.
"Our current theory is that ice on the road caused the vehicle to lose control. The driver was likely conscious initially and managed to crawl out of the car," the officer said. "Unfortunately, he couldn’t hold on and lost consciousness. There are no surveillance cameras in that area, and not many people pass by, so we don’t know how long he was exposed to the cold."
Liu Banxia nodded. "No wonder his body temperature was so low. He’s lucky to be alive. His heart was barely beating in the ambulance, and he went into cardiac arrest as soon as he arrived at the hospital."
"Dr. Liu, shouldn’t his condition have improved upon arrival then?" the officer asked curiously.
"It depends on the circumstances. He was frozen through. The hospital’s temperature is higher than in the ambulance, so the sudden change was significant," Liu Banxia explained with a smile. "The human body is quite amazing. If he had arrived even a minute later, the outcome might have been different. It’s as if his survival instinct kicked in; otherwise, he might have gone into arrest from the cold right at the scene.
"Even so, we performed CPR for over three minutes. We don’t know yet if there’s any brain damage. But he’s breathing on his own now, so we’ll have to wait until he wakes up to assess further."
The officer nodded. Despite witnessing many accidents, his medical knowledge was limited.
"Teacher Liu, we were wrong. We didn’t fully consider the patient’s actual condition," Li Hao and Huang Bo chimed in, approaching him.
"It’s okay to make mistakes; the important thing is to learn from them," Liu Banxia nodded. "I’ve told you before, as interns, you still have room for error. But what happens when you become residents? If you encounter a major incident then, with no one supervising you directly, you won’t have the luxury of making mistakes."
"Take a break, and then make sure to monitor the patient who has vivid dreams closely. Especially since he also has sleepwalking episodes; the female nurses might get spooked if they see him."
"Yes, Teacher Liu! We’ll take care of all the monitoring tonight," Huang Bo quickly volunteered.
"That’s more like it. After all, you made a mistake. Go on," Liu Banxia said with a smile, nodding.
The two, looking greatly relieved, hurried off towards the inpatient ward upstairs.
