The Enhanced Doctor

Chapter 1144: Chapter 1144: Choices Are Made at Every Moment

(Thanks to Memory Injury, Cool Wolf, sincostgctg, l-sj, for the best monthly ticket encouragement)

"How’s your situation going? I heard there was quite a commotion yesterday?" Huang Ying asked.

"We’re still waiting for the results, waiting for the results from the higher authorities, as well as the test results of that patient," Liu Banxia said.

"Anyway, I’m not going to worry about it. I’ll accept whatever the outcome is. I had some feelings yesterday, but today it’s no big deal. If I encounter it again, I’d still make the same choice."

"In trauma care, many patients have to deal with bleeding issues. Some patients have serious injuries and need surgery in the emergency room to stop the bleeding."

"Isn’t it about time for the tests? Aren’t you going to check it out?" Huang Ying asked with a smile.

"How should I put it, I actually do want to go up, but I’m worried it might be awkward to meet the patient’s family," Liu Banxia said.

"Still a bit worried, just waiting for the results. Can’t even review the patient’s information for tomorrow’s surgery, but fortunately, they aren’t too complicated."

"Director Liu, they’re bringing in a car accident patient soon, with serious injuries. His electric tricycle is deformed, and he just went into shock in the ambulance," Qi Wentai shouted at this moment.

"OK, Huang Bo and I will handle the case, prepare blood bags," Liu Banxia responded.

With extensive experience in receiving patients, this one was losing a lot of blood, already causing hemorrhagic shock.

After putting on the surgical gown, he waited directly in the hall.

"25-year-old male, blood pressure 80/50, heart rate 130, body temperature 39 degrees. Large areas of contusion and laceration on the chest and abdomen, shock in the ambulance, blood and fluid replenishment," the paramedic pushing the patient said.

"Rescue Room One, transfer him to the bed, immediately get an X-ray, ECG, rapid blood tests, abdominal ultrasound, rapid replenishment of blood and fluids," Liu Banxia hurriedly said.

"Did the patient mention any illnesses before going into shock? Did he disclose any other information? His temperature is a bit too high."

"No, his condition was already not good, he went into shock just after getting blood and fluids," the paramedic said.

"Come on, one, two, three, transfer to the bed, start the examination," Liu Banxia shouted.

Everyone moved into action. Despite Liu Banxia not giving certain instructions, they were used to handling so many emergency patients, so the routine procedures were very familiar.

"OK, clear the area, take X-rays of the chest and abdomen," Liu Banxia said.

Frowning at the screen, Liu Banxia noted the situation.

"The abdominal situation doesn’t look good, but nothing major in the chest. How’s the ECG?" Liu Banxia asked.

"There’s evidence of atrioventricular conduction block, and the heart rate remains high," Huang Bo quickly said.

"Time is tight, no time for a CT scan, quickly do an echocardiogram, call cardiology, inform the OR to prepare," Liu Banxia said.

After saying that, he began auscultating the patient’s heart again.

Time was tight earlier; the abdominal distension and rigid abdominal wall indicated severe internal bleeding, which was supported by X-ray images.

But now the patient had a high fever, and the ECG was abnormal; he needed to determine if there were heart issues as well.

This creates a dilemma, as he can only choose one course of action.

Although pressed for time, after a simple auscultation, Liu Banxia frowned deeply.

The heart sounds are coarse and loud, indicating a problem.

"Teacher Liu, everything is ready," Huang Bo said.

Liu Banxia removed the stethoscope and carefully examined the images on the screen.

"Here, there’s a vegetation on the mitral valve, endocarditis. Notify the lab for another blood culture, urgently," Liu Banxia said, pointing at the screen after a moment.

"Endocarditis? Mitral valve replacement?"

As he finished speaking, Chen Xuehai’s voice came in.

"A tricky situation, car accident patient, judging by his clothes, he’s a delivery worker. The family hasn’t been contacted yet, large abdominal bleeding, suspected spleen rupture," Liu Banxia said.

"Try to contact the family as much as possible, sigh... what a headache," Chen Xuehai also frowned.

"Let’s go to the OR first, preparations will take a while, hopefully, we’ll make contact. If we can’t, should we use a biological or mechanical valve?" Liu Banxia asked.

"If the family can’t be contacted, we’ll have to use a domestic mechanical valve. The key is the need for anticoagulants, which might affect your side’s prognosis."

"There’s no other choice, at least there’s hope for recovery. I’ll handle the abdominal area first, this way we can buy more time and get the bleeding under control."

"Alright, let’s proceed," Chen Xuehai nodded.

For this patient, the ideal situation is to contact his family, to get authorization or an opinion from them.

Because the costs for this rescue will be significant, and it’s unclear how much responsibility he bears for the traffic accident. The costs of the mitral valve replacement can’t be mixed up with the traffic accident expenses.

"I just looked at the echocardiogram images too, the vegetation is quite large, he must have had obvious symptoms before," Chen Xuehai said while scrubbing in.

"It was definitely for work. I guess this traffic accident might have been caused by his endocarditis," Liu Banxia said.

"Sigh... it’s really not easy." Chen Xuehai sighed as well.

The most prominent symptom of endocarditis is high fever, and it develops slowly. The young man’s fever has definitely lasted for a while. It’s almost been treated as a common cold and hasn’t been given much attention.

"Teacher Liu, Teacher Chen, the patient’s family’s call has been connected." At this moment, Li Tianyang ran over with the phone.

"Thank goodness, I’m still unclear about the situation here. Go and communicate with them." Liu Banxia said.

Chen Xuehai nodded, feeling a lot more relaxed in his heart.

This surgery is really not easy to perform, not only because there are many choices but also because it involves substantial expenses.

Both biological valves and artificial valves have their pros and cons. In theory, mechanical valves are recommended for patients under fifty years of age, but they require long-term use of anticoagulant medication afterwards.

So some patients opt for biological valves, with the only downside being the lifespan of the valve, but it is beneficial for the patient’s quality of life post-replacement.

"Director Liu, today is another big case; the blood test results just came in." Anesthesiologist Xu Jie said.

"Exactly, but I judge that the problem in the abdominal cavity should be the spleen. The external injuries look severe, but they are not major. Huang Bo, you’ll be the main surgeon later, and I’ll assist." Liu Banxia said.

"Alright."

Huang Bo acknowledged the doctor, and his expression became tense.

Prediction is one thing, but the patient’s actual condition is another. This patient’s situation is so critical, it’s a test for him personally as well.

"Don’t panic, our top priority in emergency surgery is to stop the bleeding." Liu Banxia said.

"Even if we didn’t have time to do a CT, we performed an abdominal ultrasound. I feel the rest of the organs are not problematic; after opening the abdomen, we’ll quickly suction and find the bleeding point."

Huang Bo, who was dressing and putting on gloves, nodded, though he was still somewhat nervous.

Liu Banxia glanced outside; Chen Xuehai hadn’t come in yet, apparently still communicating with the patient’s family.

"Teacher Liu, I’m ready." Huang Bo said after taking his position as the main surgeon.

Liu Banxia nodded.

As the abdomen was incised, a considerable amount of fresh blood surged out. However, Huang Bo, having seen many such situations, was not intimidated.

Catching blood clots and suctioning, these tasks went smoothly.

In fact, while catching blood clots, Liu Banxia had already spotted a fractured spleen. However, he didn’t remind Huang Bo, as it didn’t affect the subsequent procedure whether he saw it or not.

"Exploration reveals fractured spleen, suitable for splenectomy." Huang Bo said.

After speaking, he paused, instinctively waiting for Liu Banxia to carry out the operation.

"Don’t watch, you’re the main surgeon today, I’ll assist." Liu Banxia said with a smile.

"Oh, I almost forgot." Huang Bo hurriedly said.

"Teacher Liu, does this patient basically have no more issues now? After the quick blood transfusion, the blood pressure has been raised, and there are no other bleeding points."

"This matter is uncertain; it depends on how soon the blood culture reports positive. Endocarditis is quite dangerous." Liu Banxia said.

"Teacher Liu, did you judge just based on his ECG performance and high fever?" Huang Bo asked.

"At that time it was just a conjecture, and we were lucky. If he was only in the early stages of endocarditis, we might have missed it." Liu Banxia said.

"High fever as a symptom must alert us. Any high fever generally isn’t due to mild illness, more often than not, it’s severe infection."

"Teacher Liu, I just heard you and Teacher Chen discussing, if the family couldn’t be contacted, would we still perform valve replacement?" Huang Bo asked again.

"We have to do it, otherwise our emergency efforts won’t be successful." Liu Banxia said.

"The vegetations on his valve are already large, and the infection is severe. If we don’t address it, the patient might not recover from the abdominal surgery before passing."

"Actually, it’s hard to say right now; we have to see how quickly it reports positive. If it’s quick, the prognosis is good. We don’t yet know how the endocarditis was caused, further inspection is needed."

"We noticed earlier that his tonsils had some signs of suppuration. Could that be the cause?" Xu Jie asked.

"That might be the case; the pathways to acquiring endocarditis are quite diverse." Liu Banxia said.

"Huang Bo did a very good job, as Director Chen is also back. Should we proceed with a thoracoscope or open chest?" Xu Jie asked.

"Thoracoscope, mechanical valve." Chen Xuehai said.

"I was a bit anxious earlier, afraid that I couldn’t reach the family. Fortunately, we’re not too far from the city, and they could reach us in a bit over three hours."

"I took a risk today and opted for echocardiography instead of a CT scan." Liu Banxia said.

"That’s correct; otherwise, it would have been hazardous." Chen Xuehai said.

Sometimes this is how it is, upon receiving a patient, you face choices, and this could happen at any moment.