Chapter 201

Episode 201 Qualification to Hold a Blade (1)

The nurses moved in a rush, quickly setting up the resuscitation room. The air in the Emergency Room grew heavy in an instant. Routinely rolling the cart wheels, the nurses finished preparing for the trauma patient and powered on the monitor.

I hurriedly headed toward the resuscitation area with Kim Seo-ah, quickening my pace. Every second mattered in this urgent situation. Even mid-journey, information gathering had to continue.

"The patient?"

"A TA (* Traffic Accident). A male in his 30s. He was riding a motorcycle and was reportedly thrown off after colliding with a guardrail."

"Motorcycle vs. guardrail..."

It was the worst-case scenario. In car-versus-car accidents, the vehicle's frame absorbs some of the impact, but a motorcycle accident is essentially a bare body smashing into a hunk of iron. On top of that, being thrown off meant the momentum of the impact was massive.

Could this be a setup for possession...?

Hoping that wouldn't be the case, I left a short post in the Gallery.

[Dead Medic Gallery]

TA / Motorcycle / Thrown after collision

Author: Korean Slave 1 (Male)

Will update info if needed

[Comments]

Mes of the God (Male): Hell Slave, your posts are getting shorter and shorter...

I dismissed the window, pulled out a plastic gown from the entrance of the Resusc, and layered it over my scrubs as I questioned Kim Seo-ah. The rustling sound of the plastic grated on my nerves.

"Vitals? Not the field vitals, the ones during transport."

"BP 90/60, mental status is intact. Pulse is at 110."

"Mm, got it."

A blood pressure of 90/60 was right on the borderline of shock. A pulse of 110 meant that because the body was short on blood, the heart was pumping like crazy to forcibly maintain blood pressure—a compensatory shock. It was like a dam that could collapse at any moment. Once the dam burst, the blood pressure would plummet vertically.

Stepping into the Resusc, I shouted toward the station.

"Can someone call Professor Kim Seong-chan or Dr. Lee Minjae for today's staff? Anyone! It's severe trauma!"

"Yes! Calling them right away!"

The charge nurse picked up the handset and urgently dialed somewhere. I turned back to Kim Seo-ah and gave orders.

"Set up the FAST and portable X-ray in advance. Let's shoot them the second the patient arrives."

"Yes! Understood!"

Kim Seo-ah replied vigorously as she rolled over the ultrasound machine. Though she was only a 2nd-year and could easily get flustered, she moved quite sharply, having experienced a few trauma cases by now.

"Seo-ah."

"Yes, Teacher!"

"What about the lines? Did the ambulance crew place them?"

"Ah, they're coming in with a line secured in one arm and IV fluid running at full drop."

"One isn't enough. We need to poke the opposite side as soon as he gets here."

It was then.

Aeeeeng—!

The siren sound cut off right in front of the ER's automatic door.

"They got here much faster than I thought."

As I muttered while donning gloves, the sound of urgent footsteps and stretcher wheels rolling across the floor was heard.

Ziiing—

The automatic door opened, and the ambulance crew rushed in, drenched in sweat as they pushed the cart.

Drrrrrt!

"Aaargh..."

On the cart, a man dressed in riding gear was writhing in pain. His helmet had already been removed at the scene, and a cervical collar was firmly fastened around his neck.

"Patient! Can you hear me! Do you know where you are!"

While the nurse questioned him, the ambulance crew began shouting their handoff.

"Initial vitals were BP 90/60, but right before arrival at the hospital, it dropped to 80/50! Pulse is 120, and his mind is sagging a bit drowsy! Oxygen saturation is 90!"

"80/50. It broke."

The compensatory mechanism had collapsed. From now on, it was a race against time.

"Alright, let's move him. One, two, three!"

"Uuuugh!"

With the patient's scream, he was transferred from the ambulance cart to the hospital resuscitation bed. Checking the patient's pupils, I immediately issued orders.

"Hang 1 liter of Hartmann's through the line right away. Full drop!"

"Yes, Teacher, 1 liter of Hartmann's!"

The nurse skillfully connected the fluid set and opened the roller clamp completely.

"Give him a reservoir mask and crank the oxygen up to 15 liters. A sat of 90% won't do."

"Yessir! 15 liters via reservoir mask!"

Once the oxygen mask was placed, the patient's labored breathing echoed a bit louder.

"Secure another line in the opposite hand with a 16-gauge."

"Yes, I'll prepare it."

"Scissors!"

I grabbed the trauma shears and started aggressively cutting away the patient's clothes. They might have been an expensive riding jacket and pants worth hundreds of thousands of won, but right now, they were just obstacles hindering treatment.

Snip, snip.

The thick leather and padding were ripped away, exposing the patient's bare body.

"..."

Once the patient's clothes were completely stripped with the scissors, his highly unfavorable condition was revealed. Yet, paradoxically, it looked too clean. Aside from some abrasions on his limbs, there were no open wounds with protruding bones or gushing blood.

That was what made it scarier. His blood pressure was 80, but there was no blood flowing outward? That meant all that blood was currently pooling somewhere inside his stomach or chest cavity.

"No visible external trauma. Let's look at the FAST."

I squirted a generous amount of gel onto the patient's abdomen and applied the ultrasound probe.

"Yes, Teacher!"

I glared at the monitor while moving the probe. Between the liver and kidney, no distinct black shadow was visible yet, but it wasn't a stage where we could relax.

Right then, Kim Seo-ah, who was examining the patient's pupillary response beside me, suddenly spoke up.

"A-And!" Kim Seo-ah shouted with a resolute voice. "We'll send out the ABGA, trauma panel labs, and blood transfusion cross-matching right away! When the labs go out, please check the lactate level stat as well!"

I briefly diverted my gaze from the ultrasound and glanced at Kim Seo-ah.

She's playing at about 0.3 Baek Eunseo level.

Frowning, I pushed the gel-covered ultrasound probe deep under the patient's left ribs, where the spleen is located. Amidst the black-and-white noise on the screen, a dark shadow wavered.

"Oh... gasp... hm... hemoperi (* intraperitoneal hemorrhage)?"

A distinct black fluid was pooling in the space between the spleen and kidney.

"Ah, found it."

It was blood. I immediately pulled back the probe and shouted.

"There's intraperitoneal bleeding around the spleen! The amount isn't massive, but it's definitely ruptured. Relay this to the Trauma Surgery on-duty doctor immediately. Are they on their way?"

"Yes! They're coming! They said they'll arrive soon!" the nurse shouted urgently.

In the meantime, the portable X-ray pulled up next to the bed finished shooting.

"The images are up!"

On one of the monitors in the Resusc, chest and pelvis pictures loaded simultaneously. I bit my lip the moment I saw the photos.

"Uh... looks like a hemothorax?"

The pelvis was clean. But the chest was the problem. The area where the left lung should have been was whited out. The lung parenchyma was collapsed, and the space was filled to the brim with fluid. A rib fracture had likely ruptured blood vessels in the lung or chest wall.

"It's a massive hemothorax."

At this level, it was only natural he couldn't breathe. The blood was crushing the lung and compressing the heart.

Just then, the Resusc automatic door opened and Lee Minjae arrived.

"What's the situation?"

The moment he entered, he donned gloves while scanning the monitor and the patient back and forth.

"Motorcycle traffic accident. FAST shows bleeding near the spleen. However, that part isn't severe..." I pointed at the X-ray image on the monitor with my finger. "The hemothorax is large. The left side is completely whited out. It looks dangerous."

Lee Minjae's eyes sharpened.

"The volume is substantial. The mediastinum has shifted too."

Ding—

Ding—

The patient monitor beeped anxiously. The oxygen saturation refused to climb past 88%, and the blood pressure was barely hanging on in the 80s.

Lee Minjae made a quick judgment.

"Hm... are you going to insert a chest tube right away?"

"We have to. If we don't do it right this second, a tension setup will trigger an arrest."

I turned to the nurse and shouted.

"Please prepare a 28 French and crack open a chest tube kit immediately! Betadine and forceps too!"

"Yes! Prepared!"

The nurses unfolded the tray at a rapid speed. I was about to pick up a scalpel but hesitated.

Lee Minjae was standing next to me. He was senior to me in years of experience, and above all, his procedural skills while clear-headed were far more stable than mine. While I faltered, Lee Minjae naturally stepped in front of me.

"I'll do it."

I readily handed over the scalpel.

Right. I accepted it internally. Without a ghost's help, Lee Minjae's hand skills in a normal trauma situation are better than mine.

Lee Minjae was an Emergency Medicine fellow. There was no need for me to step forward and play the hero. Right now, teamwork was what mattered. Possession and skills should only be used at critical moments.

"Understood."

I grabbed the patient's arm to stabilize his posture. Lee Minjae liberally applied betadine to the patient's left flank.

"Lidocaine."

"Here."

"Making the incision."

Slit.

The scalpel sliced through the patient's skin. He dissected the muscle, carving a path toward the pleura.

"Kelly, please."

Clack.

Lee Minjae slid the Kelly forceps between the chest wall.

Pop.

Along with the sensation of the pleura puncturing, the sound of trapped pressure escaping was heard.

Pfft.

Pshhhhh...

Like air leaking from a tire, the blood and air trapped inside the chest cavity sprayed out of the gap.

Gush, gush.

Dark red blood began pouring into the drainage bottle through the inserted tube.

500cc.

800cc.

"It's coming out. Decompression is done for now."

Just as Lee Minjae felt relieved and was about to secure the tube—

"Oh."

My gaze and Lee Minjae's snapped to the monitor at the same time.

Something was screwed up. Obviously, if the chest tube was placed and the blood drained, the compressed heart should expand and the blood pressure should rise. Instead, the numbers on the monitor flashed red and began screaming.

Ding—

Ding—

Ding—

[BP 70/40 mmHg] [HR 145 /min]

Far from rising, the blood pressure was breaking through the floor and heading into the basement.

"70 over 40! BP is dropping!"

I urgently shook the patient's shoulder and shouted.

"Patient! Patient! Can you hear me?"

"Uuuh... aaah..."

The patient, who had been responding in agony just a moment ago, now had vacant eyes. They couldn't focus, and his eyelids trembled.

"Mental status has changed! He's stupor! No response to pain!"

The blood flow going to the brain was cutting off.

"Ah, this is driving me crazy."

The compensatory shock had passed its breaking point. While the pressure in the chest cavity had decreased as blood drained through the chest tube, the remaining blood inside his body was simply too deficient to begin with. On top of that, the splenic bleeding inside his belly likely hadn't stopped either.

Securing the rest of the chest tube, Lee Minjae shouted.

"Let's go with another liter of Hartmann's! Full drop!"

"It's running!"

Lee Minjae's blood-soaked hands moved busily. I made an immediate judgment. Peripheral vessels couldn't handle this speed.

"Dr. Minjae! Snag a C-line (* Central Venous Catheter)! A thick one in the neck!"

"I'll catch it!"

Without hesitation, Lee Minjae pushed aside the chest tube set and pulled over the central line kit. I turned my head toward the station and shouted at the top of my lungs.

"Did the ordered pRBC and FFP arrive? If they're here, use the rapid infuser and connect them the moment the C-line is caught!"

"They're almost here! Just one minute!"

The Resusc was a complete madhouse. I turned toward the cart to prepare for the next procedure.

It was then. I witnessed the 2nd-year, Kim Seo-ah, hurriedly running over while holding something heavy and massive with both hands.

"Uh? You..."

That was an open thoracotomy set, something you only see in operating rooms.

With a trembling voice, Kim Seo-ah asked.

"T-Teacher. Do we have to crack him open? Are you going to do it?"

...What on earth is this now.

Granted, it was a situation where we might have to crack the chest, but he hadn't arrested yet. To think a 2nd-year brought that over already and was looking at me with a look that said, "It's ready, Chef."

Just how far has my reputation been distorted?