Chapter 401: A Bald-Faced Lie
“Go on.” Zheng Ren tucked his left hand under his right arm, his right hand ma.s.saging his temple. He squinted at the scan clipped to the viewer.
“Here. This is the cla.s.sic sign of trauma-induced pulmonary edema.” Su Yun tapped on a spot on the scan. “But with multiple fractures, the volume of blood loss is up to a few hundred milliliters so pneumothorax is often observed.”
“The lack of a hemopneumothorax worries you?”
“Yes,” Su Yun said conclusively. Only an optimistic fool would think the lack of a pneumothorax meant good news for the patient.
Su Yun was no such fool.
He spoke his thoughts without sugarcoating them.
“I agree. The patient’s blood pressure is low. At his age, the normal blood pressure should be around 120 to 130. The pain from the fractures should see a spike in his blood pressure at around the 150 to 160 zone. Instead, it’s in the 90s. It’s quite concerning,” Zheng Ren concurred.
Low blood pressure typically indicated bleeding.
Whether it was from the laceration or rib fractures, bleeding in the chest cavity would most certainly show up in the CT scan.
However, the patient’s CT scan did not show any signs of bleeding.
Even the System did not provide any hint of severe complications. A tear in the lung could be severe or minor.
Under normal circ.u.mstances, the patient would be sent to the cardiothoracic department for further observation. They would monitor the patient’s progression and decide the course of treatment when they had more information.
Zheng Ren and Su Yun had other thoughts. They were worried that once the problem presented itself, it would have been too late.
A booming voice cut through their discussion. “Su Yun! Why would you consult me on a case like this?”
They turned around and saw the cardiothoracic department’s chief resident, Cao Guozhen.
He was a man of great stature. One could say he was built like a bear. He turned heads wherever he went and spoke.
His tone had a hint of exasperation. Su Yun and Zheng Ren figured it was because they stole the limelight during Yang Lili’s emergency rescue.
Cao Guozhen glanced at the scan before smirking.
“This is a cla.s.sic sign of trauma-induced pulmonary edema. Why are you both scratching your heads at this?”
Thousands of possibilities ran through Zheng Ren’s mind. Su Yun ignored Cao Guozhen’s mockery and continued to mull over the case, a deep-set frown on his face.
“You guys just want to keep the patient in the emergency ward, don’t you? Well, you can have him. A piece of advice, dose him with hormones then administer 10mg of dexamethasone daily with nebulizer treatment for the inflammation and phlegm. Muscosolvan can be administered through IV, 100 bottles a day. Ignore what the guidelines[1] say.”
His words fell on deaf ears.
“If you follow the guidelines, the patient will exhibit hypostatic pneumonia after the third day. Don’t say I didn’t warn you,” Cao Guozhen continued muttering.
It was sound advice.
Su Yun knew the oral medication—Muscosolvan—was cheap and had no side effects. Back in Imperial Capital, the highest dose he had witnessed was 300 bottles in a day. The solution was pumped intravenously for 24 hours.
The patient had to alternate resting on their sides to prevent hypostatic pneumonia. Most patients could be discharged within a week.
However, Zheng Ren and Su Yun believed the case was not as clear-cut.
Whether in the emergency department or the cardiothoracic department, the first few hours of a patient’s arrival was vital…
The patient could die if the wrong rescue protocol was initiated.
It was a slim chance but a chance nonetheless.
Medicine was an experimental field that emphasized empirical data.
Without any supporting evidence, how could one insist on an exploratory thoracotomy? What if the patient died on the operating table?
After a few minutes of thought, Zheng Ren realized why Su Yun had called him back.
Su Yun wanted to perform an exploratory thoracotomy but did not have the qualifications.
Like how Zheng Ren would go to Old Chief Physician Pan to seek protection from any landmines, Su Yun was doing the same.
“We can’t follow your advised treatment. We would at least have to perform an emergency fracture internal fixation surgery,” Zheng Ren turned to Cao Guozhen and said.
Su Yun was shocked.
Zheng Ren’s words were as blunt as a sledgehammer.
The patient’s fractures were simple and did not require internal fixation.
Yet, this was the best excuse they could come up with, right?
“Yes. Look here, the dislocation is clear. The fractures might have lacerated the pleural membrane and lung when the patient was moving around, causing a hemopneumothorax,” Su Yun said confidently as he pointed to a small fracture on the scan.
In normal situations, a chest CT scan was to visualize the layers of muscle. It was rarely used to determine bone fractures.
To a.n.a.lyze bone fractures, a 64-slice CT scan with 3D reconstruction was needed.
With the chest CT scan’s limited view, Su Yun pinpointed a spot and exaggerated the fracture.
Cao Guozhen was confused.
Was the emergency department in dire need of patients that they had to resort to a bald-faced lie?
No wonder the general surgery department never bothered to argue with the emergency department.
The emergency department team was basically giving the other departments an ultimatum.
Cao Guozhen considered his options before saying, “Alright then, let’s get the patient to the operating room. I’ll perform the surgery.”
“You?” Su Yun said disbelievingly, a playful smile on his face. “Can you even handle anything other than the fracture? Ever done a lobectomy? A bronchial sleeve resection?”
“You…” Cao Guozhen wanted to kill Su Yun.
He had been kind with his words, maybe there was some sarcasm mixed in.
How dare Su Yun degrade him like that? Was he a rabid dog?
“Bring over ten rib clamps,” Su Yun ordered. He exhaled upward through his mouth to fluff up his fringe.
“What? Why?”
“Do you want to go to the medical administration? Or Old Chief Physician Pan? We don’t have time to follow your advice. If we ask Old Chief Physician Pan, he would insist on the emergency department handling the chest treatment. It’s just setting up a chest drainage system. Even a nurse can do it and you want to call it a surgery?” Su Yun chuckled.
It was incredibly embarra.s.sing for Cao Guozhen.
However, Cao Guozhen knew what Su Yun said was true. If his department chief found out he lost the chest treatment, he would never be forgiven.
He exhaled deeply before turning to leave.
“Admit the patient. I’ll inform Xie Yiren and the others to prepare for surgery,” Zheng Ren said.
“Okay.” Su Yun nodded. He watched Zheng Ren’s retreating figure and called out, “Thank you, boss!”
“It’s nothing. I have faith in you.” Zheng Ren waved his hand.
[1] This method of Muscosolvan administration was demonstrated by Dr. Chen Houkun 15 years ago. Dr. Chen had used this method to save a few patients who suffered from severe chest trauma, trauma-induced pulmonary edema, and hypostatic pneumonia. I once had a patient, whom even the ICU had given up on, recovering after 26 days of treatment. The patient even came back to visit me once.