Chapter 30

Episode 30 Airway Management is Important (3)

Sitting on the sofa in my officetel, I repeated the process of tearing and sewing the throat in the void dozens of times. Gradually, this class started becoming interesting.

ㅇㅇ(211.36): Hey! Keep your mind sharp! Next question!

A new anatomical image was uploaded.

The epiglottis. A small lid that opens and closes the airway.

Under normal circumstances, the epiglottis should be thin and pinkish, but this one was swollen blood-red. The severely swollen epiglottis looked as if it would burst at any moment, completely blocking the already narrow airway.

ㅇㅇ(211.36): Hey! This is a patient whose neck is severely swollen due to Acute epiglottitis! He is barely breathing right now, but it's a situation where it wouldn't be strange if the airway became completely blocked at any moment. Intubation must be done right away. In this case, what tube size do you use and how do you handle the treatment!

Oh, boy.

This is a trap.

If I carelessly shoved the laryngoscope in, it could stimulate that sensitively swollen epiglottis and cause a complete airway obstruction. Breaking out in a cold sweat, I desperately wrote down the answer in my mind.

Korean Slave 1 (Male): You have to use a tube smaller than usual. About 1 to 2 sizes smaller.

ㅇㅇ(211.36): Reason?

Korean Slave 1 (Male): Because the airway will be swollen overall. There is a high probability that the size usually used won't go in.

ㅇㅇ(211.36): Correct. Then, what else should you be careful about? What do you prepare, and what do you need to watch out for? Explain in detail.

I squeezed my brain. For now, stimulation must be minimized.

Korean Slave 1 (Male): Do not carelessly press the tongue or stimulate with a laryngoscope. Stabilize the patient as much as possible. Especially in the case of a pediatric patient, making sure they don't cry or struggle to calm them down is the top priority.

Just then, the Pediatric Ghost appeared like a ghost.

Pediatric Ghost: Hey! Now you finally sound like a doctor! You must never thrust something like a tongue depressor that presses the tongue at kids! The moment they see that, get shocked, and cry, the airway gets blocked and they can turn blue right away! They should be held by their mother, as comfortable as possible, and just given oxygen gently!

Anesthesiology and Pain Medicine: And this is not a procedure to be done in a treatment room in the corner of the Emergency Room. As a rule, the most experienced doctor should perform it with an otolaryngologist and an anesthesiologist on standby. If intubation fails just in case, the ENT has to cut the neck and perform a tracheostomy on the spot.

Mes of the God (Male): If you touch that with your garbage hand, it's 100% airway obstruction. Just watch from the side, and if it really doesn't work out, cut the neck as I taught you.

I engraved the taught contents into my mind. And as soon as that lecture ended, the next image was uploaded.

ㅇㅇ(211.36): Okay, next is a patient with blood gushing from the neck!

Before my eyes, the throat of a patient who had received a tonsillectomy appeared. Whether a blood vessel in the surgical site had burst, blood-red blood was spouting out from deep inside the throat like a fountain.

ㅇㅇ(211.36): The reason would be secondary bleeding after removing the tonsils or something like that! What are you going to do in this case? Blood is just a step away from blocking the airway. What should you prioritize right now? The patient cannot breathe and the saturation keeps dropping.

Ah, wait a minute, what was it? Shouldn't the blood be sucked out first?

Korean Slave 1 (Male): Suction?

ㅇㅇ(211.36): Suction is taken as a given, you brat!

Anesthesiology and Pain Medicine: Suction is a given, and next is airway management. After clearing the tongue and blood clots all at once with the laryngoscope blade that has the biggest head, you have to shove the tube in as quickly as possible to secure the airway and inflate the cuff so blood doesn't pass into the lungs!

Airway management, and airway protection.

I see.

Note, note.

That way, sitting on the sofa in my officetel, I repeated the process of killing and saving the patient in the void dozens of times.

The alarm rang. Same time, same sound. It was a signal that it was time to return to hell. Lifting my body, which had become tattered from the study, I mechanically prepared to go to work. Well, what can I do.

The AM in the Emergency Room passed quicker than expected. There was surprisingly not much work, and since the mild patients accounted for the majority, it didn't become a big burden.

The PM in the Emergency Room was like a marketplace, as always. I was cooped up in a corner of the station, charting a simple laceration patient who had just come in. An uncle who had stumbled while drunk and slammed his head into the asphalt.

"Gosh, this gentleman. You should drink alcohol in moderation."

Muttering to myself, I continued charting. The boring and consuming routine of the Emergency Room with nothing special. After dealing with about ten of these patients a day, I feel like my soul becomes tattered like a gauze soaked in disinfectant.

Just then, "Han!"

The voice of the senior nurse at the triage desk rang out.

"Could you come this way for a moment? A patient just arrived, and I think we need to see him right away."

That one word from a veteran nurse always sends a chill down my spine. Shiver. I saved the charting I was doing and stood up from my seat. Going in front of the triage desk, a young man who looked to be in his early 20s was sitting on the chair with a thoroughly terrified expression.

I approached the patient and pulled a chair to sit.

"Yes, patient. What brought you here?"

At my question, the man looked at me with anxious eyes and answered.

"Uh... I had a tonsillectomy last week. But I smell something bloody and feel like there's something there..."

Aha, wait a minute, tonsillectomy? A bloody smell?

"You said you had tonsil surgery a week ago. You mentioned a fishy smell in your throat and a foreign body sensation, could you tell me in more detail?"

"It's not that my neck hurts or anything... but I keep smelling something fishy in my throat... and every time I swallow saliva, I feel like something is surging up. It feels so uncomfortable..."

For now, reassuring the patient, I picked up a penlight.

"Yes, could you open your mouth wide just once? Let me look inside your throat."

The man opened his mouth. I shone the penlight to examine the deep part of the throat, the area where the tonsils were cut out. At first, there didn't seem to be any particular abnormality. However, the moment I secured the view by slightly pressing the tongue with a tongue depressor, I saw it.

The scene where blood-red drops of blood were oozing from a very minute gap between the scabs of the surgical site. It was slow, but it was surely a currently active bleeding.

My mind went blank. Right now, it was leaking bit by bit like that, but it was a time bomb where no one knew when the blood pressure would rise or a wrong cough would cause the blood vessel to completely burst.

'I'm screwed.'

Faking calmness as much as possible to hide my expression, I asked the patient. I desperately hoped my voice wouldn't tremble.

"Did you happen to receive the surgery at our hospital?"

"Yes. A week ago, from the Otolaryngology Professor Kim Jae-young..."

At the same time as hearing the patient's answer, the hellish training of the ghosts flashed through my mind like a kaleidoscope.

'Hey! It's a patient with blood gushing from the neck!'

'This is airway management. Airway management is the top priority, you dummy!'

'After clearing the tongue and blood clots all at once with the laryngoscope blade that has the biggest head, you have to shove the tube in as quickly as possible to secure the airway and inflate the cuff so blood doesn't pass into the lungs!'

...Crazy, is this why the ghosts made me practice airway management? Are these bastards shamans or what? Ah, they are ghosts. Is it a ghost's hunch or something like that?

"Patient, listen carefully to what I say from now on. There is some bleeding at the surgical site. It doesn't mean it will unconditionally go to a big problem, but just in case, to prepare for a real, just in case scenario, I will start a few measures."

Turning away from the patient, I started shouting toward the nurse standing behind me.

"Please empty a bed in Area A for this patient quickly! We will start monitoring right away! It's post-OP bleeding!"

At my urgent shout, the air of the peaceful Emergency Room froze in an instant.

"And please secure two IV lines on both sides right now! Send out CBC and coagulation tests as STAT, and prepare 4 packs of PRBC cross-matching right away!"

My mouth had no time to rest.

"Call the ENT on-duty doctor right now! Tell them active bleeding is seen post-tonsillectomy! Tell them they need to come down right away!"

Taking a breath, I gave the final order.

"And... please prepare the largest size laryngoscope blade, a 7.5 size tube, and a suction machine, and put them next to the bed. Right now."

The nurses started moving in perfect order. One caught the IV fluid line, and another attached the patient's label to the blood sample tube. Fortunately, it didn't bleed a lot. For now. But this kind of bleeding can turn explosive at any time.

First, until the ENT and Anesthesiology arrived, there was only one thing for me to do. Maintaining the current situation as stably as possible.

"Nurse, please give me a Bosmin ampoule, a long Kelly, and packing gauze."

I requested the necessary items from the nurse. After a while, the items contained in a stainless steel tray arrived. I carefully soaked the gauze in the Bosmin solution. And I firmly held the gauze at the end of the long forceps.

"Patient, I'm going to press the bleeding spot for a moment to stop the bleeding. It might be a little uncomfortable. Open your mouth wide."

Explaining to the patient, I carefully pushed the forceps deep into the throat. Found it. I located the tonsil surgery site. Like that, I started pressing the bleeding site tightly with the long forceps.

The patient frowned. Comforting the patient, I maintained a constant pressure on the hand holding the forceps.

Just then, a indifferent voice was heard from behind.

"What is it?"

Even without turning my head, I could tell who it was. Emergency Medicine 3rd Year Han Jae-on (Male). Before I knew it, Han Jae-on had approached my side and was looking down at this scene with his hands in his pockets.

Holding the forceps, I turned only my head slightly and started briefing.

"A 22-year-old male, who received a tonsillectomy at our hospital's ENT a week ago. Showing post-OP bleeding signs, so currently packing with Bosmin gauze for now. Active bleeding is not severe, it's about oozing. Vitals are still stable, and I've notified ENT and Anesthesiology."

Listening to my briefing, Han Jae-on lowered his head and took a glance at the patient's throat.

"Hmm. It's oozing. It didn't burst arterially. For now, keep pressing like that until ENT comes."

Ending with those words, she went back to the station. What, you're not going to help me? As soon as that thought arose, Han Jae-on picked up something and started coming back this way. Aha, so he didn't run away.

I focused on the patient again. I could feel the pulse transmitted through the forceps. Fortunately, I didn't feel blood oozing out from the pressure site anymore. It seemed the pressure hemostasis was effective.

Phew, even so, it's a relief that the bleeding isn't severe. At this rate, it will end with cauterizing the wound. A sigh of relief came out naturally. Fortunately, there is no need to use that hellish airway management technique the ghosts taught me today. As expected, reality isn't that dramatic. Because not every patient rushes into the worst-case scenario.

Looking at the patient's stable vital signs floating on the monitor, I was just waiting for this boring time of pressure to end quickly.