novelraw Chapter 317 - 172: This Stitching Technique? Targeted Measures (Part 3)
Chapter 317 - 172: This Stitching Technique? Targeted Measures (Part 3)
Li Jingsheng ignored Ruan Xiaoqin.
Instead, he looked at Professor Wu with a serious expression.
After speaking, he didn’t linger but quickly went to find Director Hua to help rescue the patient.
The patient’s condition isn’t particularly severe yet, so Professor Wu is still calm enough to think about the cause. As the condition quickly progresses, there might not even be a chance for rescue.
In clinical rescue, when encountering such situations, the general approach is to provide some life support first.
For example, if blood pressure is low, then increase it.
If breathing is poor, then provide oxygen or use a ventilator.
Experienced senior doctors will make a preliminary assessment based on the patient’s condition. If there’s time to think about the cause, they won’t act rashly.
Li Jingsheng directly ran to Director Hua’s office.
Knocking on the door.
After a moment, Director Hua’s slightly muddled voice came from inside.
"Please come in."
Clearly, he was taking a nap.
Directors and senior physicians are often over forty years old.
For doctors that are a bit older, getting an advanced title at 42 is considered young for a senior physician.
Many only achieve it in their fifties or even spend their whole lives as associate seniors.
"Director Hua, the patient in bed 25 suddenly fell into a coma, the situation is really bad, Professor Wu asked me to get you to help rescue the patient."
"I’m on my way!"
Upon hearing of the emergency, Director Hua’s sleepiness quickly dissipated.
He stood up and hurried toward the door.
"Aren’t you supposed to be working in the outpatient department? Why did Professor Wu make you run errands in the inpatient ward?"
Director Hua brought him in not to be a gofer but to manage half of the workload in the outpatient clinic.
"I came over to rest for a bit at noon and coincidentally ran into the patient rescue situation, so Professor Wu called me to help."
Naturally, Li Jingsheng wouldn’t mention to Director Hua that Professor Wu was giving him a hard time.
That would be too low.
At Director Hua’s level, as long as things are described honestly, he would have a pretty clear judgment.
Reporting one leader’s foibles to another is a major taboo in the workplace.
"What’s the patient’s situation?"
Director Hua asked.
"The patient’s blood pressure is dropping very quickly, the systolic pressure is only 78mmHg, heart rate up to 120 beats per minute, breathing is heavy, shallow coma, showing signs of hypoxemia. The treatment performed was knee-tibia bone cement infusion, beyond that I’m not too sure."
Li Jingsheng briefly summarized the known situation.
"It must be the patient with osteomyelitis leading to a tibial cavity. How could treating a leg lead to a coma? It was supposed to be just a small lower limb surgery!"
Director Hua was also a bit bewildered.
Sometimes when things are bound to happen, they can’t be stopped.
These are often unexpected events.
When the two entered the ward, some rescue measures had already been applied to the patient.
"Has the cause been identified?"
As soon as Director Hua entered, he immediately became the highest authority.
The command of the rescue automatically fell into his hands.
"Not identified. Just administered two vasopressor shots, it had a slight effect, not too good. Considering the patient’s hypoxemia, we’re temporarily trying to have her use oxygen to see the effect."
Professor Wu ultimately didn’t adopt Li Jingsheng’s suggestion, opting instead for the simplest bedside single-nostril oxygen.
"The patient’s blood oxygen levels have risen slightly, now at 87%."
Ruan Xiaoqin said beside them.
"Blood pressure has stabilized, even risen a bit, systolic pressure at 80mmHg."
Good news came continuously.
Western medicine’s symptomatic treatment is often immediate.
Clinical rescue generally achieves pretty good results.
However, Li Jingsheng was not optimistic about the results.
He harbored a strong sense of crisis, believing the improvement in the patient’s signs was just an illusion, soon to revert to the original state.
As the real cause hadn’t been identified.
Nevertheless, using this method to buy more rescue time is also a good tactic.
Some causes are difficult to identify and require more time.
"May I take a look at the patient’s condition?"
Li Jingsheng sought permission from Director Hua.
Now that Director Hua was in charge, Li Jingsheng could seize the opportunity to demonstrate his competence.
If he offers constructive advice in this rescue case, his status within the department would significantly rise.
Bone setting is a technical skill, but in the eyes of many doctors, it’s simply ’grunt work.’
Just as internal medicine often looks down on surgery as only being adept with a scalpel.
The hierarchy of disdain is ever-present.
"Sure, however you need to check, coordinate with the ward staff. Young doctors should be like you, proactive, not timid or afraid of taking responsibility."
Director Hua readily agreed, casting a meaningful glance at Ruan Xiaoqin and the others at the end.
Ruan Xiaoqin and the others inevitably held scornful expressions as they watched Li Jingsheng examine the patient.
Lacking skill, being proactive won’t matter.
Having received permission, Li Jingsheng walked to the bedside to examine the patient.
Physical examination is always the most direct and effective initial diagnosis method.
Trying to flip open the patient’s eyelids, he discovered subconjunctival petechiae.
Then he opened the patient’s mouth and briefly checked; no oral bleeding or blisters present.
"May I borrow a stethoscope?"
Li Jingsheng got engrossed in the examination, listening to the patient’s heart and lung sounds.
Professor Wu and the others naturally didn’t hold high hopes for this newcomer, even thinking Li Jingsheng was a bit eager to perform, with strong utilitarian motives.
Their first meeting with Li Jingsheng had been confrontational, leaving a lasting unfavorable impression.
Director Hua and Professor Wu were already engaged in discussion within the ward.
Carefully examining every potential risk area.
Upon completing the auscultation, Li Jingsheng had some theories.
A Minor Achievement level diagnosis in pulmonary medicine remains commendable.
While listening to lung sounds, he heard a muffled percussion note, moist rales, especially prominent upon percussion.
Based on his diagnostic experience, the patient quite possibly had pulmonary edema.
Recalling the patient complaining of feeling hot and stuffy last night, wanting to open a window for ventilation. Could it be last night the patient’s lungs already had issues?
The likelihood was very high.
When pulmonary edema occurs, breathing becomes difficult, feeling stifled.
Lijiang City’s weather last night was reasonable, no stifling heat before it rains.
When the patient felt stuffy last night, issues might have already arisen.
Pulmonary edema, subconjunctival petechiae, high fever, rapid heart rate, sharp blood pressure drop, shallow coma... These symptoms combined render Li Jingsheng’s diagnosis far richer.
Just like solving application problems, each new known condition enhances the accuracy of the solution.
Reducing difficulty significantly.
"How has your mother been urinating since the surgery? Is it far less than usual?"
Li Jingsheng queried a girl.
She might see Li Jingsheng as young, instinctively reluctant to engage.
Out of politeness, she only nodded symbolically.
"Pretty much."
Instead of continually questioning the family, Li Jingsheng took the nursing records directly.
Post-surgery, it’s standard to record urine output, blood pressure, etc.
"There’s been a significant reduction in urination!"
Consistent with his predictions.
"The patient underwent tibial bone cavity cement infusion surgery. Post-surgery, exhibited pulmonary edema, high fever symptoms, excluding allergies and infections, what could it be?"
He began to ponder earnestly, trying to decipher diagnostically.