Chapter 220

Episode 220 Pixie (3)

[What? What do you mean by that… I only heard he fell off his bicycle. What do you mean his leg is in danger?]

The mother's Voice coming from the Handset Started to tremble. She probably thought it was a simple bruise and was planning to come over leisurely, so this must have sounded like a bolt from the blue. Out of empathy, I wanted to calmly explain the pathophysiology to reassure her, but right now, the Patient in front of me was in an ultra-emergency state where his leg Muscles were dying by the second.

“Right now, there is a high possibility that the Blood Vessel going to the student’s leg is blocked. Once you arrive at the Emergency Room, we will explain everything to you in person again. Someone from the Emergency Room administration office or a Nurse will Call you one more time regarding the consent form, so please make sure to answer it. Please drive safely on your way here.”

[Ah, yes… Yes! Teacher! I’ll go right away!]

Click.

As soon as I heard her answer, I ended the Call and shoved my phone into my pocket. The Guardian’s Shock was a problem for later. For now, we had to save the leg first so we could either be resented or thanked.

I whipped my Head around and shouted, “Eunseo!”

“Uh, yes, Teacher!” Baek Eunseo (Female), who had been staring intently at the Monitor, looked up in surprise.

“Call Thoracic Surgery and Trauma Surgery right away!”

“Both of them?”

“Yeah, both of them for now! Tell them it looks like an acute arterial occlusion!”

It was a high-energy blunt trauma from crashing into a truck with a bicycle. Whether the broken Bone had torn the Blood vessel, or the internal wall of the Blood Vessel had been ripped off by the impact, creating a thrombus that Completely blocked it, was still unknown. Since the Artery was blocked, Thoracic Surgery had to be the main team involved, but since it was caused by trauma, backup from Trauma Surgery was also absolutely necessary to rule out other organ damage.

“Yeees!”

Realizing the severity of the Situation, Baek Eunseo (Female) immediately picked up the Handset and began furiously dialing the hospital's internal Call numbers.

“Give me the Doppler here!”

At my urgent Shout, a Nurse quickly ran over, opened the cart drawer, grabbed the handheld Doppler ultrasound Machine, and rushed back.

The student lying on the Bed spoke in a completely frozen Voice, “Excuse me, Teacher…”

The arrogant and rebellious attitude from a moment ago had completely vanished. With Doctors and Nurses shouting and running Around right Before his eyes, the adolescent boy’s pride was shattered, and terror began to flood in.

“Student, listen carefully,” I said, squeezing clear, cold ultrasound gel onto the Doppler probe.

“Yes, Teacher.”

“We’re going to do a test called a Doppler exam. It Checks the pulse through Sound. But if my Expectation is correct, we might have to undergo an Amputation on your leg.”

“…What?”

All color drained from the student's Face. It was an incredibly blunt warning, but right now, we urgently needed the patient's cooperation and a bone-deep awareness of the Situation.

“I’m not trying to scare you. Right now, the Blood Vessel is blocked, so Blood is not flowing to your toes. If we just waste a few hours without getting Surgery like this, that’s what will happen. I’m just letting you know how serious and dangerous your current situation is.”

“…Yes. I, I’ll listen to you carefully.”

As soon as I heard his answer, I placed the Doppler probe on the patient's perfectly fine right instep. On the right side, a very normal and healthy triphasic wave pattern was visible, clearly showing the changes in systolic and diastolic Blood flow. It meant the Blood was pumping and flowing down well.

‘Now, the painful left side.’

I lifted the probe and pressed it alternately against his pale left instep and behind his medial malleolus.

Zzzzzing—

On the left side, there was absolutely no regular pulsation like the one from a moment ago. A Silence where not even the faintest gurgling Sound could be caught.

‘This… seems completely blocked.’

If it couldn’t even be caught by a Doppler, it was evidence that the microvessels at the tips of his toes had Already begun to dry up.

“Let’s check the duplex ultrasound right away! Pull the ultrasound Machine over here!”

“Yes, Teacher!”

With a handheld Doppler, we could only know the result that the Artery was blocked; we couldn’t see exactly where in the leg it was obstructed. I turned on the Monitor of the giant mobile ultrasound cart that the Nurse had pushed over and switched my grip on the probe. The area where thrombi most commonly get caught or where Blood vessels are torn due to trauma had to be checked by tracing down from the thick Blood vessels in the groin area. I boldly lowered the student’s pants to the groin Line and started the ultrasound scan.

‘Let’s see… Sigh…’

A bitter Groan Leaked out of my Mouth as I stared intently at the screen. The common femoral artery, the largest and most important Blood Vessel that travels down the pelvis and connects to the thigh, had a dark, murky lump completely filling the Inside of that Artery. It was a hypoechoic thrombus clearly observed on the ultrasound Image. And starting from that thrombus, the color Doppler Blood flow, which should have traveled down highlighted in red, was Rapidly severed as if it had been chopped right off.

‘There’s no DVT, but… the femoral head or the pelvis took a hit during the crash, tearing the intima and creating an arterial clot.’

The golden time was a maximum of 6 hours. Considering the Time already wasted after the Traffic Accident while he walked here, we had to open the Operating Room right away, slice the Blood Vessel with a scalpel to scrape out the clot, or bypass it.

“Han Sam!” Baek Eunseo (Female), who had been holding onto the phone, came running over in a frantic rush.

“What is it?”

“They said to run a CTA first! Right now, all the Thoracic Surgery professors are in OP and can’t come out right away! At least for Trauma Surgery, the on-duty Teacher can come down within 10 minutes!”

It was the worst timing. The Thoracic Surgery staff, who should have been the First to attach themselves and clear the Blood Vessel, were all trapped in the Operating Room with other patients' bellies and chests cut open.

“I was planning to do that anyway. Tell them that I confirmed the femoral artery is completely blocked by a thrombus via ultrasound, and that we’ll shoot the contrast media to take a CT as soon as the Labs come out!”

Although we had roughly pinned down the Position with the ultrasound, a 3D CT angiography was essential to draw a navigation map for which area to incise and by how much in the Operating Room.

“Yes! If the Thoracic Surgery operation runs long and they can’t do the Surgery, should I check on transferring him in advance?” Baek Eunseo (Female) suggested the next step with the quick judgment characteristic of an emergency medicine doctor. If Surgery couldn't be done here, we had to put him in an Ambulance and fly him to another Hospital before his leg started to rot.

“Yeah… tell the 1st Year to check if Thoracic Surgery at a nearby university hospital is available for Surgery.”

“Yep!” Baek Eunseo (Female) ran back out toward the Station.

“The transfer cart is ready!” The Nurses and the orderly attached themselves to both sides of the patient's Bed.

“Let’s go.”

With that, we hurriedly sent the Patient off to the emergency CT room.

I was Sitting side-by-side with the Trauma Surgery Fellow Im Seonghyun and Baek Eunseo (Female), staring intently at the results on the PACS Monitor.

In the black-and-white cross-sectional Image on the Monitor, the Ray of the Blood Vessel that had been traveling down the pelvis, highlighted in white thanks to the contrast media, abruptly snapped near the groin as if cut by a knife. It was a pitch-black zone of Despair (2) where Blood could not pass.

“From the left EIA distal to the CFA… yes, it’s a contrast defect.” My Voice sank heavily.

“If it's like this, then Surgery is definitely…” Trauma Surgery's Im Seonghyun wiped his dry Face and made a groaning sound. It wasn’t a level that could be dissolved with something like a thrombolytic agent. No contrast enhancement was seen at all in the 3–4 cm section spanning from the distal left external iliac artery to the common femoral artery. Furthermore, edema and hematoma were even visible around the affected area.

A clear Diagnosis had come out without a shadow of a doubt: traumatic occlusion and thrombosis of the common femoral artery caused by a bicycle handlebar blunt trauma. While speeding on a bicycle without brakes, he had slammed his groin straight into the corner of a stationary truck's cargo bed. Instead of breaking a Bone, the intima of the thick Artery had been torn off, clumping together into a clot and plugging up the Blood Vessel.

“Eunseo?”

“Ah, yes. I heard Professor Song Jiyeon from Thoracic Surgery has 20 minutes left in her OP!” Baek Eunseo (Female) reported urgently, taking the on-duty phone away from her ear.

She was the only savior who could open up the Blood Vessel and sew on an artificial vessel or a harvested vein.

“Contact Professor Song again and ask about the OP plan and things like that. As for the transfer…” Im Seonghyun chimed in with a grim Expression. “Since it takes time to transfer anyway, just tracking down a rescue vehicle, putting him in an Ambulance, and securing an Operating Room at another Hospital will waste at least an hour. You said Professor Song can do emergency surgery right after her OP finishes, right?”

When I asked, Im Seonghyun nodded and replied, “Ah, yes. That is true, but… as for whether Surgery is possible…. There are no issues with the brain or other parts, though. No signs of pneumothorax or bleeding in the chest area either.”

It was a stroke of luck amidst misfortune. Since there was no bleeding pouring out inside his Head or Stomach, as long as that one leg could somehow hold out, his life wouldn’t be in danger.

From the direction of Area A where the Patient was lying, a loud Sound of a shaking Bed echoed along with hurried footsteps.

“For now, IV fluids are running through the Line, but… Sigh…” Just as Im Seonghyun was looking at the Chart, contemplating the next treatment:

Beep—

Beep—

The Monitor Alarm Sound rang out.

“The patient’s BP is dropping a bit!” shouted a Nurse.

“What?”

I hurriedly stood up and looked across the Monitor toward the Patient.

Pitter-patter.

Trauma Surgery's Im Seonghyun hurriedly rushed to the Patient and started immediate emergency care, ordering Blood and administering vasopressors, while Baek Eunseo (Female) stuck close to his side to assist.

‘Wait a minute… if it’s like this.’

I froze in My Spot. It meant that because the Blood Vessel was Completely blocked, severe ischemic Shock had hit the entire lower body, or microvessels we missed on the Image had ruptured, causing Blood to pool inside the pelvic cavity. Whichever it was, the conclusion was one and the same.

‘He can’t hold out, can he?’

20 minutes. The absolute minimum time required for Professor Song Jiyeon’s surgery to finish, for anesthesia to reset the room, and for this Patient to be moved so a scalpel could be applied.

I hurriedly threw my gaze into the Void and turned on the blue window.

[Dead Medic Gallery]

Title: Emergency;; What do I do

Writer: Korean Slave 1 (Male)

Bicycle TA patient.

Traumatic occlusion and thrombosis of the common femoral artery.

20 minutes left for Thoracic Surgery's operation, but BP suddenly dropped. Is there any way?

As soon as the post went up, the ghosts of the Gallery swarmed in instantly.

[Comments]

ㅇㅇ (118.235): Gotta do surgery.

Mes of the God (Male): Is there any answer other than surgery? Gotta scrape out the clot or make a bypass.

└ Korean Slave 1 (Male): That surgery is only possible in 20 minutes.

Hippocrates' Descendant: O living doctor! Have you finished all emergency care?

└ Korean Slave 1 (Male): Other doctors are doing it.

Even if they transfused Blood and squeezed out vasopressors, the limit was clear. If the physically destroyed and blocked pipe wasn’t opened, the Patient would die. In my desperate mind, I pulled a Familiar resuscitation technique out of my head.

└ Korean Slave 1 (Male): Can’t we do something like REBOA? Do it with Zone 3. If we float a balloon in the lower aorta and block the blood, the blood pressure will be caught.

└ Mes of the God (Male): Is REBOA some kind of cure-all?

└ Operating Room Ghost 3 (Male): No way. The blood pressure might be caught temporarily, but the leg is 100% amputated.

└ Thoracic Surgery Deadbie: First of all, is bleeding even the cause?

└ Thoracic Surgery Deadbie: If you mess up REBOA in an ischemic injury, you’ll only worsen the situation. Find the exact cause of the dropped BP.

…Damn it. Even the ghosts are like this. Is there really no way…?

└ Korean Slave 1 (Male): Then what if the BP drops a lot?

└ Operating Room Ghost 3 (Male): Thinking that you'll sacrifice the leg, you should at least do REBOA. If bleeding is definitely the cause.

└ Korean Slave 1 (Male): The vitals haven't collapsed yet though.

Should we abandon the leg to save the life? It was the Moment my Head was becoming a mess.

‘Uh?’

A single memory flashed through my sweat-drenched head like a bolt of lightning. Wait a minute. Acute limb ischemia. Common femoral artery occlusion. Damage control in traumatic arterial injuries.

‘Surely, when I was studying with the gallery members before…!’

An ultra-emergency trauma Patient where the Operating Room couldn't be secured or there was no time to intricately sew the Blood vessels together. However, a makeshift technique used in a life-or-death situation where if Blood flow wasn't established immediately, the patient's limb would die and they would lose their life from Shock.

└ Korean Slave 1 (Male): Temporary vascular shunting.

This was it. Finding the torn and blocked Blood Vessel, chopping off both ends, shoving a sterilized plastic Tube between them, and tying it off with thread. An extreme trauma procedure that establishes a crude and rapid temporary pipe connection without intricate vascular anastomosis, allowing Blood to flow to the leg and correcting the Shock. Surely, with this. If it were this. We could hold out for 2 hours, let alone 20 minutes.

The moment I posted that sentence, the ghosts' comment window fell into a momentary Silence.

And 1 Second later.

└ Mes of the God (Male): Hell Slave.

└ Mes of the God (Male): Are you a fuck*ng genius??????????