He was aware that Miao Xiaohua was Xie Yiren's best friend who had previously been hospitalized in the Sea City General Hospital gastroenterology department due to acute pancreatitis secondary to binge-eating.
If he was not mistaken, the extravagant group had coincidentally met with Miao Xiaohua when they had gone for a barbeque a few days ago.
Had she not been discharged from the hospital? Why was she on the brink of death now?
However, judging from Xie Yiren's simple explanation, Zheng Ren presumed that Miao Xiaohua had most likely gotten sick rather than fallen victim to kidnapping or other bizarre accidents.
If an emergency case was sent to the hospital and treated in time, its mortality risk would decrease drastically.
Medical facilities and various advanced equipment such as ventilators had gradually become standard in the current medical world. Even terminal patients could survive for another three days when connected to a ventilator.
"Slow down, where are you? I'm coming over now!" Even though his nerves were slightly soothed, he still cut to the heart of the matter immediately.
"The gastroenterology…" Xie Yiren's mental state was presumably in tatters as she immediately burst into tears after managing to squeeze the address out of her throat.
Zheng Ren quickly ran out of the emergency ward. When he passed the doctor's office, he instructed Yang Lei to keep an eye on the house and call him in case of an emergency.
Not caring if Yang Lei had clearly heard his instructions, Zheng Ren tried his best to console Xie Yiren through the phone as he sprinted straight to the gastroenterology department in the second admission building.
Was it an acute exacerbation of pancreatitis or another disease? Numerous thoughts whizzed through his mind as he tried to figure out the situation.
A few minutes later, Zheng Ren reached the gastroenterology department, out of breath.
Patients with hematemesis were often admitted to the gastroenterology department, which was why a resuscitation room was built specifically for them. At this moment, Xie Yiren was kneeling beside the bed, weeping silently while holding Miao Xiaohua's hand firmly.
The font on the System panel on the upper right corner of Zheng Ren's vision was painted red as if fresh blood would splatter onto the floor then and there.
A ruptured pancreatic pseudocyst complicated with hemorrhagic shock.
Uh… It was a pancreatic pseudocyst!
This uncommon disease momentarily stunned Zheng Ren.
Clinical manifestations of a pancreatic pseudocyst were mainly based on the stages of acute or chronic pancreatitis.
Pseudocyst secondary to acute pancreatitis was characterized by pyrexia, upper abdominal pain and tenderness, abdominal mass and distention, gastrointestinal dysfunction and so on; various compilations could occur in severe cases.
Recurrent chronic pancreatitis-induced pseudocysts were usually smaller, and their main clinical features paralleled the manifestations of chronic pancreatitis such as upper abdominal and lower back pain, lipid metabolism disorder, hyperglycemia and many more. Splenomegaly and upper gastrointestinal bleeding were pathognomonic of this disease.
However, there was another special complication—intracystic hemorrhage!
That was what caused Miao Xiaohua's ruptured pancreatic pseudocyst.
An enlarged pancreatic pseudocyst could incorporate adjacent blood vessels—around the pancreas and upper abdomen—into its wall.
This included the splenic arteries and veins, along with the left and right gastric arteries and veins.
Activated pancreatic enzymes and infection could erode blood vessel walls and cause a sudden rupture and hemorrhage. Patients could develop severe persistent abdominal pain, increasing abdominal mass, signs of inflammation and also clinical manifestations of internal bleeding that would soon escalate to a state of shock.
This was a fatal condition! A series of thoughts flashed past Zheng Ren's mind, his body automatically secreting a large amount of hormones, breaking down ATPs and releasing stored chemical energies within high-energy phosphate bonds, normalizing his heart rate at the same time.
His mind was now prepared to perform emergency resuscitation.
The nurses in the gastroenterology department had completed venous cannulation and blood sample collection in a short period of time, proving their professionalism.
Miao Xiaohua's coat had been cut open as no one cared about its brand. No matter how expensive clothes were, were they more valuable than a life?
Her blood pressure, heart rate, respiratory rate and blood oxygen saturation displayed on the ECG monitor had dropped to a critical level.
"Central venous line kit," said Zheng Ren in a deep voice.
The nurse from the gastroenterology department was stunned for a brief moment and then immediately reacted.
It was difficult to locate a vein using a needle with a larger diameter in a patient with hemorrhagic shock, which was why they had managed to use a smaller bore needle to establish a venous channel, barely keeping her alive.
That was the best they could do. After all, if blood was transfused through a cannula with a small internal diameter, the patient would be dead before the blood bag was fully used up.
Zheng Ren's voice shocked Xie Yiren. With misty eyes, she turned around to make sure that she was not hallucinating and dived into his embrace, crying out loud at the same time.
She had just witnessed her bestie suddenly collapse before her.
From a lively, carefree, youthful, beautiful girl…
To an ashen-faced, critically ill patient at the end of her life.
Xie Yiren had witnessed the whole process in less than ten minutes and had now completely collapsed as well.
This was different from resuscitating patients. Regardless of how one treated the patients like family, the most they could feel was empathy. One's reaction would vary hugely when relatives or friends were involved.
Fortunately, there was still a large difference. If all medical personnel mentally collapsed like Xie Yiren in rescue operations, how many people would perish?
Xie Yiren found some closure in her unfaltering trust in Zheng Ren, and his broad c.h.e.s.t provided her an infinite sense of security.
"Ding-dong!"
The System's mission alert rang out unexpectedly in Zheng Ren's mind after its long hibernation.
[Continuous Mission: Indestructible Trust.
[Task: Fulfill Xie Yiren's wish.
[Reward:
[1. Passive ability—unlimited Charm. Each successful surgery grants a chance to gain others' admiration that can be used to increase Charm. Charm is related to Toughness and Reliability.
[2. 100 skill points, 1000 experience points and a gold c.h.e.s.t.
[Time: 2 hours.]
Zheng Ren ignored the System. In fact, he did not even hear the mission alert as his mind was currently focused on how to pull Miao Xiaohua from the brink of death in this urgent rescue operation.
Moreover, there was a delicate softness in his embrace…
Patting Xie Yiren's soft, furry head in silence, Zheng Ren brought her to the side and asked her to quietly stay put. After that, he quickly turned around, took a pack of sterile gloves from a nurse's hands, tore it open and proficiently put the gloves on.
"Open the central venous line kit," Zheng Ren instructed as he approached Miao Xiaohua.
During resuscitation, anyone who gave medical instructions would be the backbone of the rescue operation, but it was a risky task due to the tremendous stress one had to endure.
A happy ending would follow a successful resuscitation, but the backbone would have to take the fall if the operation ended up in failure.
Once the sterile kit was opened, Zheng Ren first disinfected the area of the skin over the planned insertion site before holding the hollow needle in his right hand while searching for a vein with his left finger.
Zheng Ren had demonstrated his impressive capability during the nitrite
poisoning rescue operation. Focusing his entire attention in the moment, he pierced the needle through the skin and immediately noticed a flashback of blood.
"LMW Dextran at full speed!" Zheng Ren barked, attaching the infusion drip.
Chapter 163 - Hybrid Surgery
Unlike a dextrose solution, low molecular weight dextran and amino acid solution—abbreviated to LMH Dextran—was a colloid and a necessity in fluid resuscitation.
Many disliked the usage of LMH Dextran due to the rare possibility of an allergic reaction.
However, under current circ.u.mstances where plasma and red blood cells had not been delivered, it was the correct decision to administer dextrose solution and LMH Dextran at the same time.
As for the allergic reaction…
Rather than worrying about such small risks, it was better to treat the hemorrhagic shock first.
"Speed up the blood delivery, and send a doctor to wait at the blood transfusion department!" Zheng Ren continued to give orders without considering himself an outsider.
The doctors in the blood transfusion department had no idea whether the patient was in a critical state, dying or just having a normal disease. If blood retrieval was handled according to the waiting list, the patient would be dead before the blood bags were delivered.
Moreover, nurses carried no weight with the blood retrieval process as it was basically one of their jobs.
If a doctor was sent to explain the situation to the blood transfusion department, every procedure would be performed urgently, and blood could be transfused before Miao Xiaohui departed this life.
There was not much time left for Zheng Ren. This was the only way.
More importantly, there were plenty of staff working in the day.
Removing the pair of sterile gloves, Zheng Ren took out his phone, dialed a number and said in a croaky voice, "Gastroenterology, resuscitation, come immediately."
He hung up immediately after.
A nurse standing beside the infusion stand used a pressure bag to increase the infusion rate of LMH Dextran.
Zheng Ren began to examine Miao Xiaohua. She had lost consciousness and her abdomen was distended, presumably due to blood acc.u.mulation. There was no way he could locate the source of the bleeding under such circ.u.mstances.
'F*ck you, System!' he grumbled internally.
He had been complacent when he first acquired the power of the System because it was simply an awesome hack, but he once again felt powerless after consecutively encountering numerous critically ill, dying patients.
'Why don't you tell me where the source of the bleeding is?! A diagnosis of ruptured pancreatic pseudocyst complicated with hemorrhagic shock isn't enough!'
He also had to have a rough idea of potential bleeding spots before proceeding with exploratory laparotomy. If he had to search for everything under a surgical lighthead, Miao Xiaohua would most likely be dead by then.
A few minutes later, Su Yun arrived at the resuscitation room in the gastroenterology department.
He immediately understood the situation after a quick scan and approached Zheng Ren, asking softly, "What's the diagnosis?"
"Ruptured pancreatic pseudocyst complicated with hemorrhagic shock," said Zheng Ren.
"..." Su Yun was dumbfounded.
The rarer the disease, the more difficult it was to manage due to lack of clinical experience.
The chances of survival in an acute exacerbation of a rare disease was almost zero.
"Do you know which blood vessel has ruptured?" asked Su Yun, understanding the primary focus of the matter.
"I don't know." Zheng Ren shook his head and immediately made up his mind. "Perform an angiography in the interventional radiology suite and proceed with laparotomy afterward."
"..."
This was the second time Su Yun felt speechless today.
Even though he was a postgraduate student from a well-reputed medical institution with powerful innate talent, he had never seen a hybrid surgery before.
The international radiology suite was actually a hybrid operating theater, but no one had performed any open surgery there, nor was anyone experienced in this domain.
"Are you sure?"
"There is no other way."
"Okay." Su Yun, the perfect surgical assistant, did not question Zheng Ren's decision.
After glancing at the data on the ECG monitor beside Miao Xiaohua, Su Yun and the medical staff of the gastroenterology department started performing their duties.
The transferral from the gastroenterology department resuscitation room to the interventional radiology suite in the emergency department carried a huge risk—the possibility of Miao Xiaohua going into cardiac arrest during the journey was over thirty percent.
Thirty percent seemed small but was an unbearable possibility to everyone involved.
Chu Yanzhi, who had been informed of the situation, rushed over with a tracheal intubation kit.
In less than ten minutes, 10U fresh frozen red blood cells, thawed by the doctor and nurse of the gastroenterology department along the way, were delivered to the emergency building; the patient was already intubated with a self-inflating bag.
Fortunately, the hospital bed elevator was unoccupied and the journey went on smoothly.
Apart from a quick halt to change a blood bag, they wasted no time along the entire way.
Miao Xiaohua's blood pressure was already undetectable when she was transferred to the operating table in the interventional radiology suite.
Chu Yanran, who had performed all necessary anesthesia preparations, immediately administered the necessary drugs for surgery.
Old Chief Physician Pan, who had also arrived at the scene, began to perform every legal procedure from the hospital's perspective. Even though Miao Xiaohua was a nurse in the hospital, he remained cautious and summoned staff from the medical administration division, adhering to standard medical protocol when informed consent was unobtainable.
Xie Yiren followed the stretcher trolley to the emergency building, and as usual, changed her attire and performed a surgical scrub.
However, as soon as she stood before the instrument table, tears started to stream down her cheeks.
Fortunately, the concept of asepsis had embedded itself into the deepest part of Xie Yiren's soul, so she subconsciously moved away from the instrument table, preventing its contamination that would necessitate a new sterile surgical kit being opened.
It was not because of the cost of a surgical kit, but the waste of precious time.
This hybrid surgery was unprecedented in Sea City General Hospital, or in fact, Sea City itself.
Despite the lack of communication, everyone coordinated with each other smoothly.
Old Chief Physician Pan handled every procedure outside the suite and sorted out every detail in an orderly manner.
The matron of the operating theater immediately put on a lead apron and entered the suite to prepare the necessary surgical instruments for laparotomy for Zheng Ren's interventional surgery later.
Even though Miao Xiaohua did not have cardiac arrest, the ECG monitor reported that she was currently having atrial fibrillation. Since medication had to be administered to prevent deterioration, Chu Yanran and another nurse also put on lead aprons and entered the operating theater to stand by for further instructions.
This operation was completely different from any they had had in the past. No one was trained for this, and there was no response plan, either.
However, thanks to all involved personnel's combined effort, all preoperative preparations were complete within twenty minutes.
As Su Yun put on his lead apron and scrubbed up, Zheng Ren began to disinfect and dr.a.p.e the surgical site before inserting the needle.
The surgery was once again broadcast live in Xinglin Garden.
[It's boring to watch surgery all the time; can the god sing for us?]
[You don't have to stick to this channel. There are many beautiful girls in other l
ivestreams.]
[That's right. You have a severe disease, best if you can get yourself checked.]
A few comments flew across the screen as soon as the livestream started.
Since all surgery recordings had been deleted, everyone who had subscribed to this channel knew that they had to read the case first and gain information before the surgery began. That way, it would be more rewarding when the host surgeon performed a complicated, uncommon operation.
The comments were surprisingly few today. Most viewers had turned off the comment section, refusing to communicate as they wanted to concentrate on watching the livestream.
However, dead silence dominated the live broadcast room after they read the case.
A hybrid surgery. The host surgeon was broadcasting a hybrid surgery today!
Chapter 164 - Race Against Time Part I
Disappointment bubbled in the audience when they found out the surgery livestream was no longer recorded. Regardless of the outcome, the surgeries broadcast on this site were worth a thousand replays.
[Hybrid procedures… I've only heard of them.]
[At least you've heard of them. I had to search on Baidu to find out what they were.]
[I think only Class Three Grade A Hospitals in major cities have hybrid operating suites and most of them are newly-built. Union, Fuwai and West China1 only had their hybrid operating rooms after the expansion.]
Comments were sparse as most doctors were focused on the ongoing surgery.
A pair of steady hands appeared onscreen—they crossed over occasionally to manipulate their instruments. The right hand was coaxing the guide wire into the patient's blood vessel at an impressive speed. Within a minute, the livestream changed to the display on the surgeon's screen.
The guide wire was in place and the guide catheter followed its path. Moments later, imaging began.
There was no arterial superselection. Based on the livestream, contrast agent was administered at the main branch of the artery.
Was this an error in judgment? Or was there a reason?
The pressure injector delivered a dose of contrast agent into the artery. Zheng Ren paid close attention to the forming image.
The Surgeon's Studio c1-799 Page 84
