Chapter 236
Episode 236 Gunshot Wound (1)
“Ah, yes. Trauma Surgery on call… Yes.”
The nurse, with the handset wedged between her shoulder and ear, urgently started writing something down on a blank notepad.
“Yes, we can. Yes, we can accept them. What about the treatment on-site? Yes, the military doctor… Yes. Yes, yes.”
Scratch.
Scratch.
Only the sound of the ballpoint pen filled the area around the station.
South Korea is a country where firearm possession is strictly prohibited.
Furthermore, in a civilian university hospital emergency room, the word "gunshot wound" was considered a sort of urban legend or a line from a movie.
If it were an accident caused by a tool like a nail gun, that would be one thing, but a real firearm that uses gunpowder to blast a metal bullet?
“Yes, we can accept them. Yes, sir.”
Click.
The short call ended, and the handset was placed down.
The nurse turned her head while holding the notepad.
“They say it’s an accidental shooting inside the 58th Division base.”
“The 58th Division?”
“The Armed Forces Busan Hospital closed down, so the nearest military hospital is farther than our hospital. Above all, it’s a penetrating chest injury, so they can’t guarantee if immediate trauma surgery is possible right now. That’s why they’re currently evacuating the patient directly this way by ambulance from the unit’s medical corps for now.”
The 58th Division.
A homeland defense division located on the outskirts of the city.
Now that the Armed Forces Busan Hospital closed down in 2020, the nearest military hospital would require going to Changwon or Pohang.
“What about the vitals and the patient's condition?”
Lee Minjae asked with a hardened face.
“They say BP is 60 over 40, pulse is 140, and GCS is 8.”
The nurse quickly read down the numbers written on the notepad.
“That's not good….”
A groan slipped out of my mouth involuntarily.
No, it wasn't just a matter of being "not good"—it was a state where it wouldn't be strange if cardiac arrest occurred right this second.
Blood pressure 60 over 40.
It meant the blood inside the body was already hitting rock bottom.
An ultra-severe hemorrhagic shock where at least 30 to 40% or more of the total blood volume had poured out of the body or into the thoracic cavity.
Pulse 140.
Because there wasn't enough blood, the heart was beating like crazy, struggling desperately to somehow fill the empty blood vessels.
And a GCS (Glasgow Coma Scale) of 8.
A normal person is 15 points, so an 8 meant that the blood flow going to the brain was already insufficient, causing them to lose consciousness and fall into a coma.
A score where they couldn't even maintain their own airway right now, making intubation absolutely mandatory.
The nurse read down the next line of the notepad.
“It’s a close-range penetrating injury to the right anterior chest due to accidental shooting. They secured an IV line with an 18-gauge on both sides and are giving 1L of IV fluid. They are coming while giving a full 15 liters of oxygen via O2 mask.”
“Uh….”
Right anterior chest.
The right front chest.
If there was any stroke of luck, it was that it wasn't on the left side where the heart is located.
However, we couldn't breathe a sigh of relief.
If a bullet fired at close range pierced through the right chest, the right lung would have been blown to pieces, and there was a high probability that thick blood vessels like the pulmonary artery or vena cava were torn apart.
Moreover, it was a penetrating wound.
It was on a completely different level from a stab wound from a knife.
The moment a bullet with tremendous kinetic energy hits the human body, a giant shockwave is generated inside the tissue, creating a cavity that expands dozens of times its size.
It meant that the lungs and organs inside the chest would have been blown to pieces just as if a grenade had exploded.
The military doctor did the best they could on-site.
Inserting the thickest 18-gauge needles into both arms to pour in IV fluid and blasting oxygen.
However, a gunshot wound cannot be stopped by a mere 1 liter of IV fluid.
I had seen countless patients with broken bones or burst intestines from traffic accidents, and I had handled patients spurting blood from knife wounds.
But what were the odds of seeing a patient with a real bullet stamped inside them in a South Korean civilian hospital emergency room?
“Hyeonjae.”
Lee Minjae turned his gaze and looked at me.
“Yes, Professor.”
“Do you know how to handle a gunshot wound too?”
A question that no civilian hospital doctor who earned their doctor's license in South Korea could answer.
Lee Minjae’s voice was also steeped in a deep sense of helplessness.
“…How could I?”
How could I know how to handle it?
A gunshot wound is something that even trauma surgery subspecialists can barely catch a glimpse of in textbooks or by going on a fellowship in the United States.
“Of course you wouldn't know, right? Ha, this is driving me crazy, seriously.”
Lee Minjae frustratedly ran his hands through his hair.
The horrible destructive power, like the ballistics of a gunshot wound or the cavitation effect created as a bullet rotates inside the human body, was something he had only read about in textbook text, with absolutely zero experience in actual clinical practice.
However.
“Whether they were stabbed by a knife, pierced by an iron skewer, or shot through by a bullet….”
I stood up from my seat and loosened up my body.
“In the end, wouldn't the trauma resuscitation to plug the leaking pipe, fill back the blood that poured out, and expand the collapsed lung be exactly the same?”
There was no time to be consumed by the fear that the word "gunshot wound" brings.
Whatever the cause, the patient was a severe trauma patient dying from blood loss.
Hearing my answer, a very faint vitality returned to Lee Minjae’s hardened face.
Having finished our brief check and determination, the two of us started moving at the same time.
“Someone call the trauma team, please!”
Lee Minjae shouted.
“Activate the MTP (Massive Transfusion Protocol)! Please prepare blood products in advance! Set up the rapid infuser right away too!”
Not backing down, I also poured out words loudly enough to shake the emergency room.
Pouring normal IV fluid into a gunshot wound patient would only dilute the blood and induce a coagulation disorder.
You have to directly pour in hot blood as much as they poured out to make the heart beat again.
“Trauma team assemble, trauma team!!”
The interns ran into the Resusc holding chest tube insertion sets and emergency thoracotomy kits in both hands.
I took a deep breath and opened a blue window in the void.
Flash-
[Dead Medic Gallery]
===================
GSW
Author: Korean Slave 1 (Male)
Gunshot wound patient.
Have you guys ever seen a gunshot wound? It's in the chest.
===================
Since it was an emergency situation, I threw away all manners and just dropped the main point.
No sooner had my post been registered than the spirits, who had been causing a riot over my love life, instantly switched to serious mode and started leaving comments.
[Comments]
ㅇㅇ (118.235): Is it finally time for my Special Forces background to shine?
ㄴ Mes of the God (Male): This guy is an unregistered user.
ㄴ Thoracic Surgery Ancestor: Megod, have you seen a gunshot wound?
ㄴ Mes of the God (Male): A few times at a trauma center during my US fellowship.
‘Thank goodness.’
I let out a sigh of relief.
Latte is Mine: Shiver. Internal Medicine should back out now. I'll just be praying.
Crack the Head Open: Hm. Unless shrapnel flew toward the head, I'll just watch for now.
Anesthesia and Pain Medicine: What about the mental status? I need to check the condition for anesthesia.
ㄴ Korean Slave 1 (Male): GCS 8. BP 60 over 40.
ㄴ Korean Slave 1 (Male): I'll prepare for resuscitation first, and since I might need to use possession, everyone stay aware. Megod and Thoracic Surgery Ancestor. Both of you stand by. Go go.
I singled out the two spirits and closed the window.
Flash-
The moment the blue light completely disappeared from my view, the automatic door of the Resusc opened.
“Trauma Surgery is here!”
The Trauma Surgery assistant professor on duty, Lim Seonghyun, ran into the Resusc, panting for breath.
“Yes, we are setting up.”
I answered shortly, checking the mountain of all sorts of IV fluids and airway maintenance equipment piling up on the cart.
Lim Seonghyun started double-gloving.
“You said thoracic trauma? A gunshot wound?”
“Yes, that’s correct. It’s a penetrating right anterior chest wound.”
“This is crazy, seriously. That’s why I came quickly…”
It was before Lim Seonghyun could even finish his sentence.
Whirrrr-
The door of the Resusc opened once again, and this time, a relaxed voice of a completely different nature was heard.
“Did you call me?”
It was Professor Han Ihyun of Cardiothoracic Surgery, who is exclusively in charge of the trauma section.
Thoracic trauma.
In a situation where the heart, lungs, and great vessels might have been torn apart, the appearance of a thoracic surgery staff member provided an overwhelming sense of relief.
It felt like gaining a massive reinforcement.
Professor Han Ihyun approached the head of the bed while putting on his gloves.
“Now then.”
Weeee-woooo!!!
As soon as that short one word came out, the sound of an ambulance siren started being heard from the hospital entrance.
Lee Minjae opened his mouth with a grim face.
“Let’s get ready.”
Whirrr-
The Resusc door opened.
A nursing officer and a military doctor belonging to the medical corps ran in, drenched in sweat, pushing the bed of the blood-covered patient.
The patient’s upper clothing was stained dark red, and drops of blood were dripping onto the floor here and there.
The military doctor spoke.
“BP is 60 over 40! We caught both lines and came while giving a full run of IV fluids! Pulse is 145!”
Right up until arrival, the vitals had not recovered at all.
No.
It was a number where the fact that he crossed the threshold of the emergency room alive was a miracle in itself.
“Moving him! One, two, three!”
“I’ll do the intubation, Hyeonjae!”
Lee Minjae, who took up the position at the head of the patient, shouted as he picked up a laryngoscope.
“Yes, Professor!”
“You catch the C-line (central venous catheter)!”
“Yes, yes, understood!”
Without hesitation, I moved and started opening the kit to find the femoral vein.
It was too dangerous to catch the subclavian or jugular vein because there was a gunshot wound in the chest area.
I applied disinfectant to insert a thick catheter into the thigh blood vessel.
“Give us the blood from the MTP right away! Shoot it with the rapid infuser!”
“Yes, Teacher!”
As the nurses loaded the blood packs into the machine and increased the pressure, dark red blood started pouring in through the line.
In the meantime, Trauma Surgery's Lim Seonghyun, who took his spot on the right side of the bed, squeezed out ultrasound gel and shouted.
“Let’s do a FAST exam! Quickly!”
While Lim Seonghyun glared intensely at the ultrasound monitor, Professor Han Ihyun took charge of the patient’s right chest area.
Every time the patient gasped, a bizarre sound came out from the dark red hole.
“Blood-mixed foam keeps coming out of the hole~ Vaseline gauze. Quickly.”
Han Ihyun broadcasted the situation in a relaxed tone, as if he were watching a fire across the river.
‘How can he be so relaxed?’
I stuck my tongue out inwardly as I pushed the catheter deep into the vein.
An open pneumothorax and hemothorax state.
Even in that horrible state, I couldn't help but be shocked by the figure of the thoracic surgery professor who was treating and briefing without his breathing getting disrupted even a single bit.
“C-line is secured!”
Having firmly fixed the central venous catheter, I threw off my blood-stained gloves, put on a new pair, and immediately moved to the head of the patient.
Professor Han Ihyun was handling the thoracic trauma, Professor Lim Seonghyun was handling the abdomen, and Professor Lee Minjae was handling the airway.
If so, it was my job to determine the neurological status of the patient whose GCS had nosedived to 8.
‘The penlight is…’
I rummaged through my pocket and pulled out a small medical penlight.
Click.
I lifted the patient’s left eyelid and shined the light.
‘The left is 3mm.’
It was normal.
Reacting to the light, the pupil immediately constricted.
I let out a sigh of relief and immediately pushed up the opposite right eyelid.
And the moment I aimed the light of the penlight straight into the patient’s right pupil.
“The right is… 8mm Dilatation.”
No matter how much light I shined, the pupil remained massively dilated and did not show even a slight movement.
“Loss of light reflex! Please call Neurosurgery!”
“What?”
The 1st-year resident Yang Siu, who was helping with the records, made a dumbfounded sound.
“I said call Neurosurgery! Quickly!!”
As a roar came out of my throat, Yang Siu, whose face had gone pale, finally picked up his phone and began to frantically dial the number.
“Ah, yes, Teacher!”
The worst sign indicating that either oxygen to the brain had been cut off due to shock from the gunshot wound, or the pressure inside the skull was skyrocketing due to brain hemorrhage, starting to crush the brainstem.
To think this was showing up right now.
If we delayed even a few minutes like this, the patient would fall into a permanent state of brain death or his heart would stop.
I pulled up the window in the void.
Flash-
ㄴ Korean Slave 1 (Male): Right pupil 8mm dilated.
ㄴ Crack the Head Open: Okay, I'm ready. Just do it slowly.
‘Okay.’
Having confirmed the reliable backup sign from the neurosurgery spirit, I closed the window without hesitation.
And I snapped my head up.
“I will perform a burr hole!”
“What?”
Trauma Surgery's Lim Seonghyun stared at me while holding the ultrasound probe, and Professor Han Ihyun’s hands also faltered.
However, ignoring all those gazes, I rattled off the necessary equipment toward the scrub nurse.
“Give me a #10 blade, elevator, Hudson brace set, bone wax, and Raney clips!”
It meant I was going to drill into the patient’s bare skull right on the emergency room bed without even taking a CT scan.
“Hey, what? Hyeonjae?”
Lee Minjae, who had just fixed the endotracheal tube and stood up, turned around to look at me.
“Professor, it’s a brain herniation. We have to drill.”
“What?”
“It’s 8mm right now. There’s absolutely no light reflex, and the GCS has dropped further. If we don't drill right now to relieve the pressure, this patient will suffer brain death from brainstem compression before we can even open the chest.”
At my briefing, Lee Minjae’s face turned grave.
As an emergency medicine specialist, he too must have known better than anyone how despairing this situation was.
“Even if it’s done, I’ll do it.”
Lee Minjae adjusted his gloves and tried to approach the head of the patient.
“In a situation where Neurosurgery hasn't arrived yet, at least I, as an emergency medicine specialist, received training, so…”
“I will do it.”
I said, stepping in front of him.
“I said I’ll do it. I at least received training, but you’re a resident who has never done a burr hole even once…”
“I can do it.”
“Hyeonjae!”
“I will do it.”
Was it rashness or a hero complex?
No.
I just believed in the spirit.
It was a decision made under the calculation that the probability of the patient surviving was overwhelmingly higher if the spirit drilled while possessing me rather than Lee Minjae spinning the drill.
“Hyeonjae.”
“There is no time.”
A suffocating confrontation where 1 second felt as long as 1 hour.
After a silence, Lee Minjae tightly closed his eyes.
“…Sigh, just how many times am I going to leave my license in this guy's hands.”
Lee Minjae nodded his head.