Chapter 18
Episode 18 Is it not a cold? (2)
The Nurse checked the order and hurriedly ran to grab the Portable EKG Machine. I headed back toward the Bed where the Patient was lying.
In the meantime, Comments Started appearing on the blue interface.
Hippocrates' Descendant: O living one, hasty Judgment is forbidden. Neck pain can also be a musculoskeletal Disease.
ㅇㅇ (118.235): Wow, Sore Throat, what the fuck lol. True, it could be Radiating Pain, but you won't know until you take it.
“Teacher! I brought the EKG!”
The Nurse Started applying the Electrode with Skillful Hand movement.
The Patient looked completely terrified by the sudden commotion.
“Teacher… am I dying? It’s just my Neck that hurts, why is everyone like this….”
“Patient, it’s alright. This is just a test for confirmation, so don’t worry too much. Don’t worry about anything and stay still for just a Moment.”
I then turned to the Nurse and said, “Just in case, please bring the Emergency Cart over This way in advance. Just have it ready.”
Whirrrrr-
The EKG Machine Started spitting out a long Printout Sheet.
Please, please let it be nothing.
Let me just be a crazy bastard who made a fuss over nothing.
However, God did not answer my prayer.
The Moment I took the EKG printout sheet, my Hand trembled slightly.
“Fuck…”
A Curse slipped out involuntarily.
II, III, aVF. On the Lead showing the Inferior Wall of the Heart, the ST Segment was soaring like a mountain. A typical finding of an Inferior Wall Myocardial Infarction.
I shouted frantically, “Let’s take just one more V4R Lead!”
V4R Lead.
A Lead that checks the condition of the Right Ventricle by attaching an Electrode to the right Chest. It is a part that must be checked in the event of an Inferior Wall Myocardial Infarction.
A Moment later, on the additionally taken EKG, my worst Expectation was perfectly preserved.
Even on the V4R Lead, a clear ST Segment elevation was visible.
A Right Ventricular Infarction accompanied by an Inferior Wall Myocardial Infarction.
It wasn't just a simple Myocardial Infarction. It meant that even the Right Ventricle, which acts as an auxiliary pump for the Heart, was failing altogether.
If a Vasodilator is carelessly used on such a Patient, Blood pressure could plummet to rock bottom, and the Patient could die Due to shock.
“I’ll have the Patient chew and swallow Aspirin 300mg and Plavix 600mg right now.”
“Yes!”
“Give Oxygen 2L via nasal cannula! And you must absolutely never give Nitroglycerin! Blood pressure will drop immediately! Instead, catch one more IV line and full-drop Normal Saline 500cc!”
Only after giving the initial treatment did I finally catch my Breath.
However, anxiety Came rushing in immediately. Did I miss anything? What more should I do in this Situation?
I accessed the Gallery once again. I needed confirmation.
Title: I did this right, didn't I?
Author: Korean Slave 1 (Male)
Inferior with RV infarction. Removed nitro from MONA and did fluid loading. Do we enter PCI now? Anything I missed?
Post.
And I immediately pulled out my cellphone and opened the contact list in the Hospital.
Cardiology 당직의. Cardiology, Cardiology….
At the exact Moment I was scrolling down to find the contact info, new Comments Started appearing in real-time on the Gallery window.
Cardiology Ghost: Good job. (Icon of a dumpling giving a thumbs-up)
ㅇㅇ (118.235): You did well with the fluid loading. But have you listened to the Patient's Heart sound? An Inferior Wall Myocardial Infarction easily accompanies a Complete AV Block, so prepare for it in advance.
Mes of the God (Male): Is the Internal Medicine bastards' house-playing Finished? Cardiogenic Shock will strike at that level, so are they preparing to run ECMO before sending them up to the room? What do they plan to do if the Patient dies on the table?
Heart. Complete AV Block. ECMO.
I hadn't resolved anything yet.
Get a grip, Han Hyeonjae (Male), you piece of shit.
I cursed myself inwardly. There is no Time to panic now. I need to contact the Person who will take this Patient right now.
Cardiology.
[Cardiology Park Wooyoung]
I swallowed my saliva and Pressed the call Button.
Ringgg
Ringgg
Before the second ring could even finish, the phone connected abruptly.
Along with a noisy clamor over the Handset, a somewhat irritable Voice flew in.
“Yeah, what's going on?”
The Sound of trays clattering could be heard beyond the Voice.
It was the employee Restaurant.
‘…Oh dear, he is eating.’
I felt apologetic for a second, but immediately, another thought Brushed past my Head.
‘If he's at the restaurant, it's a 3-minute dash to the Emergency Room. Is this actually better?’
I shook off the selfish thought and stated my identity and business as quickly and accurately as possible.
“Teacher! Hello! I am Han Hyeonjae (Male), a 1st Year in Emergency Medicine. The thing is, a 54-year-old male Patient is judged to have a Right Ventricular Infarction accompanied by an Inferior Wall Myocardial Infarction, so I am calling to—”
Before my Words could even finish, a loud Sound of a chair scraping erupted over the Handset along with a shout.
“What?!?! Infarction?!?! Got it!!!!”
Click.
The call disconnected.
“?”
I stood blankly for a Moment with my cellphone displaying the call ended screen.
What is this Crazy bastard?
What does he mean he got it? Is he coming or not?
Where in the world is a Doctor who hangs up without even asking about the Patient's condition?
Two seconds later, my cellphone Started ringing like Crazy. The caller was that number from a moment ago, Cardiology Park Wooyoung.
I reflexively Pressed the talk Button.
“Hello?”
“Ah, sorry! Sorry! Hey, I didn't ask the important thing!”
Over the Handset, along with an urgent Voice, a rough breathing Sound that sounded like someone running full speed down the Hallway was heard.
“What's the Patient's condition? Tell me the vitals! I'm running right now, so I'll listen while moving!”
‘Well, if it's an infarction, it makes sense to throw down your spoon and run.’
Swallowing a hollow laugh, I Started reporting by mobilizing all the knowledge injected into me by the Ghosts yesterday and all the judgments I had made just now.
“Yes, Teacher. I will report. A 54-year-old male Patient visited the Hospital at around 12 o'clock today with a chief complaint of severe Sore Throat. Initially, it was classified as KTAS Grade 5 due to suspicion of a Cold, but the discrepancy between the intensity of pain complained of by the Patient and the examination findings was severe, so the test was conducted with the possibility of Heart problems in mind.”
“Sore Throat? Not Chest Pain?”
“Yes, that’s right. He is mainly complaining of a burning pain Radiating Pain to the Jaw and Neck.”
“Got it, keep going. Vitals?”
“Current Vitals are Blood pressure 90/60, pulse 55 beats, respiratory rate 22 breaths, Oxygen saturation 98%. Blood pressure and pulse are on a downward trend compared to admission.”
“EKG?”
The breathing Sound over the Handset grew even rougher.
“On the 12-lead EKG performed just now, an ST Segment elevation of about 3mm is clearly observed in Lead II, III, and aVF, and an ST Segment depression is seen in Lead I and aVL as a Reciprocal change. An elevation of 2mm was also confirmed in the V4R Lead of the right EKG additionally performed to differentiate Right Ventricular Infarction, so for now, it was judged to be a Right Ventricular Infarction accompanied by an Inferior Wall Myocardial Infarction.”
“So, what about the initial treatment?”
“Immediately after checking the EKG, the Patient's Consciousness was clear, so I had him chew and take Aspirin 300mg and Plavix 600mg. Currently, Oxygen is entering at 2 liters via nasal cannula. Because it is accompanied by an RV Infarction, Nitroglycerin was not administered, and Normal Saline 500cc is being loaded to maintain Blood pressure. We are still waiting for the cardiac marker results.”
Lastly, I added the advice given by the Gallery Ghosts.
As naturally as if it were my own judgment.
“And, Teacher. Bearing in mind the possibility of bradycardia and AV block that can accompany an Inferior Wall Myocardial Infarction, we have attached the defibrillator patch to the Patient in advance to prepare for any potential emergency.”
My report was completely Finished.
Nothing but rough breathing could be heard from the Handset. Did I go too far? Did I pretend to know too much for a 1st Year?
Finally, Cardiology Park Wooyoung opened his Mouth while catching his ragged Breath.
“…Hey.”
“Yes, Teacher.”
“For an EM 1st Year, your call is very clean. I'm almost there. Wait just a bit.”
…Fuck.
I just said everything without stuttering once.
At the exact Moment I was about to feel proud of myself, another comment that made my Spine turn cold came to mind.
‘Is the Internal Medicine bastards' house-playing Finished? Cardiogenic Shock will strike at that level, so are they preparing to run ECMO before sending them up to the Cath lab? What do they plan to do if the Patient dies on the table?’
That's right. No one knows what will happen during the procedure for a Patient whose Blood pressure is barely holding on because the Right Ventricle is failing like this.
The Heart could stop Completely, or they could fall into uncontrollable Shock. The last bastion needed at such a time. A Machine that replaces the role of the Heart and lungs.
ECMO.
And that is the domain of Thoracic Surgery.
Before I knew it, I urgently cut in.
“Ah, excuse me, Cardiology Teacher!”
“Uh, why?”
The rough breathing Sound could still be heard over the Handset.
“I am sorry, but I think we need to prepare for both Cardiogenic Shock and cardiac arrest. Can I call Thoracic Surgery right now to ask about a potential VA ECMO backup?”
Silence flowed for a Moment over the Handset.
An Emergency Medicine 1st Year declared to a Cardiology Fellow, ‘I will hang up for a moment because I need to contact Thoracic Surgery.’
A nobody 1st Year, that is.
Normally in this Situation, it is correct for the Cardiology Doctor, who is ultimately responsible for the Patient and will perform the procedure, to judge and make the request.
But you never know. From what I see, This person isn't in his right Mind right now either.
“Uh… uh-huh, we should! If they wonder why a 1st Year is calling, use my name!”
Okay.
Success.