...

Emergency operating room.

Lu Cheng and Zhang Tiesheng had just moved the patient onto the operating table when the anesthesiologist rushed in. After a quick glance at the patient's vital signs, he cursed under his breath.

"I'll go scrub in and sterilize the drapes," Zhang Tiesheng said.

Although he was a doctor in the emergency surgery department, they were short-handed at the moment, and Lu Cheng couldn't handle it alone.

After Han Xiaoping arrives, he can go back to stand by.

Lu Cheng said, "There's no time, Brother Zhang, just bring over the iodine, we have to open the abdomen to stop the bleeding immediately!"

"Aren't we going to disinfect?" Han Xiaoping asked.

"No time," Lu Cheng replied.

"The patient's blood pressure is already very low..."

"First, move the patient to the operating table and open the debridement pack!" Lu Cheng quickly instructed the circulating nurse.

While speaking, Lu Cheng and several circulating nurses moved the patient onto the operating table.

Seeing the circulating nurse looking a bit panicked, Lu Cheng tore open the debridement pack himself and then put on a sterile glove.

Even though Zhang Tiesheng had been in the emergency department for many years, he'd never seen such an 'urgent' situation with Lu Cheng.

"Lu Cheng." Zhang Tiesheng wanted to advise him.

"Brother Zhang, I know. First, mount the blade. As soon as Han Xiaoping comes in, we'll immediately open the abdomen to stop the bleeding," Lu Cheng said.

Before the patient's informed consent form was signed, Lu Cheng dared not rashly proceed with the surgery.

The patient's family was right there, and the supervisor couldn't make decisions on behalf of the family, so even though Lu Cheng was anxious, all he could do was wait!

If the patient dies, they die.

The law is there, and people generally have to abide by it without questioning it.

Law enforcers won't consider your doubts when executing the law.

Informed consent and informed refusal are equally important; the patient's family has the right to choose whether to rescue the patient.

Long County People's Hospital is just a county hospital; there are higher-level hospitals for referrals. The patient's family can change their mind at any time and choose to transfer the patient.

Once the consent form is signed and the surgery begins, there's no going back!

"You should get dressed," Zhang Tiesheng said to Lu Cheng.

Lu Cheng then walked over to the table where the sterile surgical gown was, donned his sterile gloves, and picked it up.

"The patient has signed," came Han Xiaoping's voice before he entered the room.

Upon hearing this, Lu Cheng immediately dropped the gown he was holding.

The circulating nurse, who was about to help Lu Cheng with the gown, exclaimed, "Hey!"

"Brother Zhang, give me the knife!" Lu Cheng said.

The anesthesiologist reminded, "I haven't started anesthesia yet."

"I know, but this patient can't wait," Lu Cheng said, glancing at the nearest blood pressure monitor.

65/42mmHg!

The blood loss was rapid.

"Actually, even if you can't save him, you're not responsible," the anesthesiologist Liang Yaozhong remarked.

Lu Cheng looked at Liang Yaozhong, "If not being able to save him doesn't make us responsible, then what is there to fear?"

Liang Yaozhong didn't answer.

Lu Cheng's response was textbook.

Without the family's consent, Lu Cheng couldn't perform invasive procedures, but with it, everything was different.

Han Xiaoping entered the operating room and said, "Brother Zhang, you should go back to the department and take a look for me."

Han Xiaoping worked the night shift in the ward, and the patients' conditions were relatively stable, usually without major issues.

But it was different in the emergency surgery department, where there might be another major case.

Zhang Tiesheng glanced at Lu Cheng. Although he wanted to stay and watch Lu Cheng's next steps, he had to leave.

Duty called, and he couldn't leave his post without a rescue mission.

Technically, Zhang Tiesheng wasn't allowed to leave the department, but the county hospital wasn't the same as a general hospital; their principles differed from those outside.

There were only so many staff available, so what could they do?

The county hospital couldn't afford to be overstaffed, as too many people would starve, and the hospital wouldn't hire so many people.

...

Lu Cheng extended the surgical incision along the patient's existing wound, and after opening the abdomen, he immediately used a retractor to spread the skin apart.

Inside the abdomen, there were multiple dark hematomas, primarily concentrated in the upper right abdomen.

"Nurse, bring another set of instruments, we're only performing a temporary hemostasis now," Lu Cheng instructed quickly.

Opening the abdomen was an emergency measure, and after temporary hemostasis, the instruments used would have to be replaced for any further surgery.

They were contaminated.

But when it comes to saving a life, the sterile principle can be temporarily ignored.

First save the life, then treat the disease!

If the life is lost, concerns about sterility don't matter.

"Liver contusion and laceration, open injury to the right lobe of the liver, massive bleeding."

"Total hepatic vascular isolation!" Lu Cheng decided immediately with just a glance.

Total hepatic vascular isolation (Heaney advanced) involves four-vessel occlusion:

Inferior vena cava below the liver, superior vena cava above the liver, hepatoduodenal ligament, and the abdominal aorta.

"Anesthesiologist, please give the patient some nitroglycerin to limit fluid input," Lu Cheng said quickly.

Similarly, Lu Cheng's actions were swift.

This patient's active bleeding wasn't from unfamiliar arteriovenous bleeding but from a very standard hepatic rupture, so it was imperative to block the total hepatic blood flow promptly.

The more time saved, the more can be gained.

Han Xiaoping and Lu Cheng worked quickly together, and within minutes, they had blocked the blood flow.

Han Xiaoping murmured to Lu Cheng, "Brother Lu, what do we do next? I wish Professor Chen were still here."

"But?"

"We'll wait for the general surgery consultation."