CHAPTER 355: 355 CRITICALLY ILL EMERGENCY PATIENTS

The patient from last night became a topic of discussion for many when they arrived at work this morning. After all, appendicitis and intestinal perforation presenting concurrently as manifestations of the same underlying disease was quite rare.

Xu Yino happily shared this case with her colleagues. Despite sleeping little last night, it had been an unforgettable experience for her.

Every doctor encounters unforgettable cases, she mused. Even though this patient hadn’t faced a life-or-death situation yet, I, Xu Yino, will remember this one for my entire life. Next time I encounter a similar patient, I’ll definitely consider parasitic infection first and order the relevant tests.

During breakfast, she video-called Qiaoqiao for a while, but she didn’t get to see Qiaoqiao; Tang Dou’s big face occupied the entire screen.

This had become routine. Currently, Liu Banxia and Tiggie were Tang Dou’s best friends. Whenever Liu Banxia had a day off, she would invariably take Tang Dou to the villa complex for a good run.

Before she had even finished her meal, Liu Banxia’s phone rang.

"Sister Li, are you at work already?" Liu Banxia asked, answering the call.

"Come back quickly! A pregnant car accident patient is about to arrive. She was ejected through the windshield, and her condition is extremely critical!" Zhou Li said urgently.

Pregnant women always held high priority among patients. This wasn’t just one patient; there was also the fetus in her womb.

Forgetting her meal, Liu Banxia immediately started running back.

By the time she returned to the emergency center, the patient had already arrived. Shi Lei was in charge of her admission.

"Sister Li, what’s the situation?" Liu Banxia asked.

"She was unconscious upon arrival with very low blood pressure. Shi Lei was concerned there wouldn’t be enough time to treat her if things escalated, so he asked me to call you. Doctors from neurosurgery, cardiac surgery, and orthopedics have all been called over. The situation is extremely urgent," Zhou Li said hastily.

"Establish two IV lines, connect ECG and fetal monitor, prepare a thoracotomy tray," Shi Lei’s voice called out.

"The skull is fractured. I’ll remove the bone fragments first to prevent further bleeding," Zhang Xiao, the attending neurosurgeon, stated.

"No breath sounds on the right side. Prepare a chest tube. Sternum fracture," Chen Xuehai’s voice added.

"Body temperature is 35 degrees Celsius, a bit low. Warm the IV fluids to prevent hypothermia. Ventricular fibrillation... Charging 120 joules... Clear!" Shi Lei’s voice suddenly became anxious.

"200 joules... Clear!... Sinus rhythm restored. Begin massive fluid resuscitation and blood transfusion. After inserting the chest tube, send her for a CT scan, then to the OR."

Although Liu Banxia was not in the resuscitation room, she could vividly imagine the patient’s injuries from the conversation filtering out. The situation was critical. A fractured skull likely meant a cerebral hemorrhage. A chest tube indicated probable bleeding in the upper right abdomen as well. And that was just the mother. A core body temperature of 35 degrees Celsius would threaten the fetus. The patient was in dire straits. Soon, they might face the agonizing choice: save the mother or the child? A C-section seemed inevitable, but could the patient’s body even withstand it?

"Banxia, you should come to the operating room later as well," Shi Lei said, emerging from the trauma bay. "The condition of her abdomen isn’t clear yet. We only had time for a brain CT. If the abdominal situation is complicated, we’ll need your help."

"Alright, I’ll go get ready now. By the way, how far along is she?" Liu Banxia nodded.

Shi Lei shook his head. "The driver died at the scene. We haven’t been able to contact her family yet. But we estimate she’s over 30 weeks pregnant. We’ll see how things develop. For now, the fetus is relatively stable."

Liu Banxia nodded again and rushed towards the operating room.

This patient’s situation was too unique and complex; they needed to be thoroughly prepared in the OR.

"Brother Zhang, what’s your assessment?" Liu Banxia asked on the way to the operating room.

"Subdural hemorrhage is likely inevitable; the CT is just to confirm its location. We might have to perform head, abdominal, and thoracic surgeries concurrently later. I’m genuinely worried the patient won’t survive it," Zhang Xiao said with a frown.

Liu Banxia grimaced. Even a healthy person would be at great risk undergoing such a combination of surgeries, let alone a pregnant woman who had just survived a horrific car accident.

"Banxia, is the situation really that critical?" asked Li Liwei, the anesthesiologist, who was already prepared in the operating room.

Liu Banxia nodded. "Our greatest hope right now is for the patient to survive the surgery."

This single sentence made Li Liwei realize the gravity of the danger, and his heart tensed. The patient’s condition is critical, and with a fetus involved, I’ll have to be extremely careful with medications and maintaining her vital signs, he thought.

After a short wait, Shi Lei and Chen Xuehai also arrived in the operating room. The patient was wheeled in. Orthopedics was not needed for the time being.

"Let’s quickly finalize the plan," Liu Banxia said. "Brother Zhang will do the brain surgery first. Shi Lei and I will handle the patient’s abdomen simultaneously. Dr. Chen, can you monitor for now? Otherwise, I’m afraid the patient won’t hold on."

"Okay," Chen Xuehai agreed. "The chest tube drainage isn’t excessive for now, and her cardiopulmonary functions are still acceptable. But when you open the abdomen, work quickly. Her blood pressure is really too low."

"Brother Zhang, let’s begin," Liu Banxia nodded to Zhang Xiao.

"Alright, prepare for craniotomy," Zhang Xiao said.

"You or me?" Shi Lei looked at Liu Banxia.

"You make the incision; I’ll locate the bleeding points. Her blood pressure is so low, I suspect severe abdominal hemorrhage," Liu Banxia said.

"Alright." Shi Lei nodded and began.

"Everyone, please be as fast as possible. I have very little confidence in this patient’s ability to withstand this. I don’t know how long I can maintain her," Li Liwei said, his voice lacking conviction.

"We’re counting on you, Brother Li," Liu Banxia said.

By now, she had no time to deal with other matters. There’s significant intra-abdominal bleeding, and her liver is lacerated. I need to suture these as quickly as possible to stop further hemorrhage, Liu Banxia thought, her attention narrowed to the task at hand.

"Everyone, push yourselves! I can see the subdural edema. Starting decompression now," Zhang Xiao urged.

"Blood pressure and oxygen saturation are temporarily stable. Her temperature has dropped to 34 degrees Celsius," Li Liwei updated.

"Dr. Chen, how’s the thoracic cavity? There are quite a few small bleeding points in the abdomen; I’m afraid we don’t have time to deal with all of them," Liu Banxia said without looking up.

"No problems here for now. Prioritize your side," Chen Xuehai replied.

"The spleen is also torn. I’ll handle it first," Shi Lei announced.

"The abdominal injuries are too severe. I suspect the damage to her heart and lungs is also likely significant. Dr. Chen, if her body can take it, could laparoscopy address the issues?" Liu Banxia asked.

"How can I say for sure? It depends on the specifics," Chen Xuehai said with a wry smile.

He was an experienced doctor and knew the patient’s body couldn’t endure such a lengthy operation. Otherwise, Liu Banxia wouldn’t have asked; after all, laparoscopic surgery was less invasive than open abdominal surgery.

"Okay, my part is done. Suturing now," Zhang Xiao’s voice carried a hint of excitement.

"We can’t hold on much longer! You need to wrap up quickly. The patient’s temperature has dropped to 32 degrees Celsius, and her coagulation is also very poor!" Li Liwei’s voice cut in urgently.

His words were not welcome news; everyone knew they had to stop operating immediately. They would have to pack the patient’s abdomen with hemostatic gauze, allowing her time to recover and her vital signs to improve.

If they insisted on continuing the surgery, the result would be even greater blood loss.

"Dr. Chen, help us pack the gauze, then I’ll close," Liu Banxia said.

Now, every moment saved was crucial to shorten the operative time, giving the patient a better chance to recover. As for how much she could recover, no one was confident.

After closing the abdomen, the patient could only be sent to the ICU for observation, and the doctors had to remain on standby. As soon as the patient’s vital signs were stable enough, they would need to perform the next surgery.

Seeing them emerge from the OR so quickly, the staff in the emergency center understood that the patient’s body couldn’t withstand the full surgery.

"Has the patient’s family been contacted?" Liu Banxia asked.

"Yes, they’ve been contacted. We reached her husband—who was the driver—using the phone number associated with the license plate. Both sets of parents are on their way," Zhou Li said.

"Sigh... let me know when they arrive." Liu Banxia let out a breath. This is devastating for both families, she thought. It’s terrible news, and whether we can save her is still so uncertain.

"Teacher Liu, we have more flu patients today. Should we pay special attention?" Liu Yiqing came over.

"Yes, monitor them closely to prevent any nosocomial infections," Liu Banxia nodded.

This patient’s case still required further discussion; it wasn’t a matter of just waiting, she thought.

"Boss, do we still need to call the Director? He has surgery today too," Liu Banxia asked Shi Lei.

"No point calling him now," Shi Lei shook his head. "The current situation isn’t medically complicated, just extremely urgent."

"The head trauma should be temporarily stable. The focus now is on the abdomen and thoracic cavity," Zhang Xiao commented.

"I’m worried about the heart," Chen Xuehai said. "The fractured ribs likely caused some injury to the heart. Let’s just hope the heart hasn’t ruptured. Otherwise, I truly don’t know how we’d save her. You two handled things quickly today. Even though not all bleeding points were addressed, at least the first phase of surgical intervention was completed."

"Should we postpone the rest of this morning’s surgeries, then?" Liu Banxia looked at them.

Chen Xuehai nodded. "They’ve already been pushed to the afternoon. Even if we finish late today, we have to see this patient through. I’m going to review the new scans and prepare for an echocardiogram."

Liu Banxia nodded. Indeed, this was merely the first phase of this patient’s battle for survival.