Chapter 219

Episode 219 Pixie (2)‌

Hoda-da-dak.

With the sound of urgently rushing footsteps, my body leaped toward the triage area. Working in the Emergency Room gives you a sort of intuition; you can gauge a patient's condition roughly just by the tone of a nurse's voice or the nuance in how you are called.

Ziiing—

As I pressed my employee ID against the scanner, the heavy Emergency Room doors slid open, completely exposing the triage area.

"Ah… ahh, ssup…"

The first thing I heard the moment the doors opened was someone groaning in annoyance. It wasn't the kind of deathly scream wrung out by excruciating pain, but rather the immature groan of someone who found the scratches and bumps from a collision annoying and bothersome.

"It's this student over here."

Where the triage nurse pointed with a jerk of her jaw, a male teenager wearing a hoodie loosely thrown over his school uniform shirt was sitting on the chair with a crooked posture. His knees looked like they had been scraped against asphalt, with blood seeping through, and his sleeves were torn. The nurse had already acted quickly, securing his neck with a rigid plastic cervical collar.

"Uh, student?" I called out, approaching him to check his condition.

"Ah… yes, hello," the student replied, shifting his weight onto one leg as if it were no big deal, turning his head stiffly due to the collar wrapped around his neck.

"What happened to you?"

Without waiting for his answer, I pulled a penlight straight out of my pocket. For trauma patients, assessing the pupil reflex is the highest priority. Even if they look perfectly fine on the outside, they could have brain hemorrhages or head injuries, so checking the pupillary light reflex is a must. I alternated shining the bright light into both of his eyes.

"Ah, it's blinding…"

As the light hit his eyes, the student frowned deeply and tried to jerk his head back.

"I asked what happened to you, student."

This isn't the time to complain about the light, kid. I clicked my tongue in my mind while scanning the pupil size and reaction speed. Just because a patient walked in on their own feet doesn't mean they are completely fine. Brain hemorrhages progress slowly before causing a sudden loss of consciousness.

Furthermore, there was the information the nurse had just handed over.

A bicycle Traffic Accident.

An accident involving a two-wheeled vehicle, where a bare body takes the brunt of the impact, can yield far more horrible results than a car-on-car accident.

Perhaps slightly suppressed by my stern demeanor, the student blinked his eyes and began to explain the situation.

"Ah, yes… well, I was riding my bike and I hit something like a truck?"

"A truck? A truck hit you?"

If he had been hit by a moving truck, there was no way he would be sitting here like this, casually leaning on one leg.

"No, no, it was a parked truck, so, yes…" The student scratched his cheek with his finger, looking sheepish.

"Why on earth did you hit it…?"

Dazed by the sheer absurdity of it, the question slipped out of my mouth before I could stop it. Why in the world would anyone crash a bicycle into a giant truck parked perfectly fine on the side of the road? Did he pedal with his eyes closed?

The student then began to make excuses.

"It's a fixie… a brakeless bike. I was riding that and couldn't stop. But I think I'm fine, so could you please take this thing off my neck?"

It seemed the student was more bothered by the ridiculous plastic cervical collar propping up his jaw than by the scraped limbs or the pain in his chest from the collision. This meant he had been speeding without any braking mechanism and slammed his bare body into a massive steel structure—the bed of a truck. Without a bumper or an airbag to absorb the impact, the patient's chest and abdomen had completely absorbed all that kinetic energy.

Though a fire of frustration brewed inside me, I struggled to maintain a calm, reassuring tone as I admonished him.

"That's a cervical collar, student. We'll loosen it after we take some pictures and check that your neck bones are fine. If you carelessly take it off and damage a nerve, you could spend the rest of your life in a wheelchair, so stay still."

I pointed out the chilling danger of spinal cord injuries. However, to a teenager whose blood hadn't even dried yet, immediate pride was far more important than medical warnings.

"It's a bit embarrassing, and I really think I'm okay…" His voice whimpered, as if he were terrified a friend might see him or ashamed that people in the Emergency Room were staring.

"What?"

There was absolutely no reason to show kindness to a kid discussing embarrassment in the middle of an ER packed with patients hovering between life and death. Let him taste the reality of Cheongjin University Hospital's Emergency Room, a place with a 1.9-star rating on Cocoa Maps.

"It's nothing." At my chilling word, the student immediately backed down.

Turning my eyes back to the chart, I rapidly ran the trauma protocols through my mind.

The scariest patients are always the kickboard, bicycle, and motorcycle riders.

They have relatively minimal protective gear compared to cars, yet frequently suffer high-energy injuries due to speed. They are ticking time bombs; just because they walked in just now doesn't guarantee they will still be breathing five or ten minutes later.

Right then, the voice of the nurse, who had attached an oxygen saturation monitor to the patient's finger, grew urgent.

"Teacher, his sat is a bit low."

Bip—

Bip—

The alarm sound, which should have been cheerful, dragged slightly. The numbers on the monitor screen visibly plummeted from 99% to 93%, and then down to 92%.

Blunt chest trauma?

Without a moment's hesitation, I gave my orders.

"For now, let's move him to Area A. Hook him up to the monitor, and let's get an X-ray right away."

"Yes!"

The nurses semi-forcibly transferred the student from the chair onto a stretcher. As the atmosphere turned deadly serious in an instant, a look of sheer panic finally washed over the face of the student who had been grumbling just moments ago.

"Student?"

"Yes, teacher…?" lying down on the bed and staring at the ceiling, he answered in a fading voice.

"Did you leave your guardian's contact info at the reception desk?"

At my pressing, the student hesitated and bit his lip.

"Ah, yes… I did leave it. But if you call my mom, it's a bit embarrassing…"

This crazy bastard.

Even in the midst of his oxygen saturation dropping, he was more terrified of getting chewed out by his mom for getting into a bike accident, bringing up that damn pride and embarrassment yet again.

I grabbed the bed rail firmly and leaned down close to the student's face.

"Embarrassing?"

To think he still hadn't snapped out of it when we might have to shove a chest tube into his chest and drain blood at any moment.

"No, sir. I will… tell her to come quickly."

It was an excellent, textbook answer. I straightened my back and nodded with satisfaction. That's more like it.

"Uh… his sat is normal?"

A voice filled with absurdity burst from the nurse who was attaching a cascade of monitor cables to the patient after laying him down in Area A.

"What?"

I stopped recording on the chart and whipped my head around. Just a moment ago, the oxygen saturation had hit 92%, making my heart squeeze. Yet, the moment the clip connected to the main monitor was placed on his finger, the numbers on the screen displayed a very stable and peaceful 98%.

"…"

I looked back and forth between the readings on the monitor and the patient's face. There was no breathing difficulty, nor was there any cyanosis. There was only a teenage boy, paralyzed with fear, just blinking his eyes.

"I told you guys to replace that pulse oximeter. That's number 4, right?"

"Ah, yes."

The nurse who had rushed over from the triage area earlier answered in a small, shrinking voice, subtly hiding the portable oxygen saturation monitor she held in her hand behind her back.

"Oh, my… rookie…"

The veteran nurse, Nurse Jeong, pressed a hand to her forehead. A headache throbbed at the clumsy mistake of a rookie whose teamwork was still lacking. Passing the frustrated triage nurse, I meticulously double-checked the patient's condition with my own eyes.

Then, quite naturally, I turned my gaze toward the void.

[Dead Medic Gallery]

Sat difference

Author: Korean Slave 1 (Male)

Back to 98 from 92. The former was a portable pulse oximeter, the latter was the main monitor.

There shouldn't be a problem, right?

[Comments]

Mes of the God (Male): ? So what.

oo (39.7): The probability of something unexpected at play is low as hell, so rest easy.

Latte is Mine: Why is this a recommended post?

Hippocrates' Descendant: Just treat the patient, young doctor!

…Well, this is awkward.

Feeling embarrassed, I quickly closed the window in the void.

Paaat—

Even so, I couldn't completely let my guard down. Although there had been quite a fuss over a machine error, the history itself—a high-energy injury from crashing into a truck on a brakeless bicycle—remained unchanged.

"Let's secure two lines with 18-gauge needles," I instructed the nurse to secure thick intravenous lines.

"Yes~"

"Let's move him to A-1 instead of here. Right next to the resuscitation area."

Because the bed where the patient lay was too close to the entrance, I ordered the bed to be pushed to the very back of the Emergency Room, right next to the resuscitation area.

"Ah? Ah, yes."

While the bed rattled its way inward, Baek Eunseo, a 2nd-year resident, came trotting over from afar holding a chart in her hand.

"What kind of patient is it?" she asked, peeking over my shoulder at the student.

"Go check the triage notes first."

At my answer, Baek Eunseo pouted her lips but immediately scurried over to the computer.

"Ah, yes."

While Baek Eunseo ran over to the computer to check the records, I couldn't take my eyes off the monitor standing at the patient's head. His oxygen saturation was normal at 98%. His blood pressure was also holding at 110/70.

However.

"His pulse is 110…. That's not good."

His pulse. His heart was beating like crazy at 110 beats per minute. For a trauma patient, tachycardia is the very first warning light. It could mean blood is leaking somewhere inside the body, forcing the heart to pump excessively to maintain blood pressure.

Having read the chart, Baek Eunseo stood beside me and lightly offered her opinion.

"Couldn't it just be hyper-excitement? A teenage boy hit a car while riding a bike, and he's probably terrified because he had to call his guardian. He must be in some pain, too."

"…"

"Even so, I believe we should run all image scans and labs! He is at an age where compensatory mechanisms are highly active, after all."

"True."

A welcome notification chimed.

"The X-ray results are out!"

At those words, I instantly pulled up the X-ray pictures on the monitor. Cervical spine, chest, and pelvis—the classic 3-piece set for a trauma patient. Since I happened to be on the phone explaining things to the patient's guardian, I was able to deliver this news right away.

"Yes, yes, ma'am. For now, on the X-ray, we don't see any broken bones or major damage in his neck or areas like that, but we'll still need to get a CT scan to check for internal organ bleeding. Yes, yes. As for the visible external trauma…"

The bones were intact. There were no clear signs of a pneumothorax or hemothorax on the X-ray either. Shifting the phone to wedge it between my neck and shoulder to free both hands, I stepped closer to the patient and spoke.

"Roll up his pants over there."

"Yes."

At the command, a nurse rolled the hem of his loose school uniform pants all the way up past his knees. The moment the pant legs were rolled up, my gaze locked onto both of the patient's legs. On the surface, except for a few abrasions scraped by the asphalt, there was no open fracture where bones protruded or bent severely.

However.

"Let's look at the right foot."

I firmly pressed down on the nail of the patient's right big toe with my finger.

Gguk.

The blood color beneath the nail, which had turned pale white, flushed back into a vivid red in less than a second the moment I released my hand.

"Let's look at the left foot."

This time, I firmly pressed down on the nail of the opposite left big toe. Capillary refill time—the most basic and intuitive evaluation of blood flow to check how quickly blood refills the microvessels in the fingertips or toes.

The left toenail, which I had pressed and released, remained a pale white and showed no signs of regaining its original color.

1…

2…

3…

4…

5?

"Uh?"

Hold on.

Normally, it should return to red within 2 seconds to be considered normal. Yet, even after 5 seconds had passed, the tip of his left foot remained pale and bloodless. Furthermore, compared to his right foot, the actual skin temperature felt distinctly cold to the touch.

Feeling cold sweat break out along my spine, and completely forgetting that the phone wedged against my neck was about to drop, I hurriedly brought both hands to the top of the patient's left foot.

Palpating the left dorsalis pedis artery and posterior tibial artery.

Heightening the sensitivity of my fingertips to their absolute limit, I struggled to find even a faint pulse.

No pulse could be felt.

Looking at the student's face, I asked urgently, "Can you feel sensation here?"

As I asked while pinching and rubbing the top of his left foot, the student replied with a dazed expression, "Ah… pardon?"

"You can't feel it well? I'm asking if you can feel my fingers touching you."

"Well… I think I can feel it, though." The student tilted his head in confusion.

It was clear that when he slammed into the truck, a major artery in his pelvis or thigh area had been torn, or a vessel had been compressed and blocked by a bone fragment. If left abandoned like this, the muscle would undergo necrosis, and his entire left leg would have to be amputated.

I picked up the phone again.

"Ma'am."

[Yes, teacher. Is my child badly hurt?] An anxious voice came through the handset.

"You, you need to come to the Emergency Room quickly."