Chapter 31

Episode 31 Airway Management is Important (4)

A boring period of pressure. I was staring blankly only at the clock hung on the station wall.

Time flowed terribly slowly. Vital Signs on the monitor were peaceful, and though the patient frowned in discomfort, he did not spit out blood anymore.

'See. It's nothing special.'

I let out a sigh of relief inside.

It was clear that the crazy ghosts throwing a massive fuss and training me on my day off was just meant to scare me.

Reality isn't that dramatic anyway.

Blood spouting like a fountain, turning blue from not being able to breathe, that kind of thing only happens in dramas—

Just then.

The patient suddenly flinched his body along with a coughing sound.

An ominous sensation of something welling up from deep within the throat.

The cough that had been held back burst out reflexively.

"Cough! Cough, cough!"

And.

Pshhhhhhh-

At the same time as the feeling of the long Kelly held in my hand being forced back completely, blood-red blood burst out from the patient's mouth like a fountain.

The blood vessel that had barely been blocked by pressure could not overcome the pressure of the cough and completely burst.

"Argh!!!!!"

Red blood splattered everywhere onto the patient's chest, my gown, and even the floor.

The patient poured out blood from his mouth.

At the same time, the machine started to scream crazily.

Beep-beep-beep-beep-!

The Oxygen saturation figure was plunging vertically from 98% to 90, then 85.

A blood clot had blocked the airway.

"W-What is this!"

My brain stopped.

Where did the peace from a moment ago go, and why was a hellscape unfolding before my eyes?

From the patient's throat, almost a blood clot, rather than just blood, regurgitated.

A gurgling sound echoed terribly.

The patient's face quickly turned blue.

"Teacher! The patient's sat is dropping! It's in the 70s!"

"Suction! Quickly with the suction!"

I lost my mind.

My hands shook violently.

The ENT department hasn't come yet?

Han Jae-on (Male), a 3rd year, went to see another patient?

Let's think.

Let's think.

Let's think, Hyunjae.

'Hey! This is a patient bleeding profusely from the neck!'

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

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

Airway, airway!

In my head, the comments of the ghosts echoed like tinnitus.

"The anesthesia department hasn't come yet, right? They're far away?"

"Yes! There's been no contact yet!"

Let's do it.

The judgment finished in one second.

I shouted while running to the head of the patient.

"What was prepared earlier! Give me the intubation set right now! Blade and 7.5 tube! Together with the suction tip!"

At my scream, the nurse hurriedly held out the tray.

With a shaking hand, I gripped the laryngoscope.

'It's the left hand. The laryngoscope is always the left hand.'

I gripped the laryngoscope again with my left hand and pried open the patient's jaw.

And I swallowed my breath at the scene unfolded before my eyes.

Hell.

The inside of the patient's mouth was already a blood-red sea of blood.

The surging blood and blood clots mixed together, making it impossible to distinguish which part was the tongue and which was the throat.

'Do suction first! If you can't see, you can't put it in! Shove in with the one with the biggest head and suck it all up!'

The anesthesia ghost had said that.

I grabbed the thick suction tip with my right hand and shoved it deep inside the patient's mouth.

Gurgle-gurgle-gurgle!

The suction machine screamed and sucked up the blood clots.

However, it was no use.

The speed of the blood surging from deep within the throat was faster than the speed of sucking it up.

The field of vision was still full of red.

Nothing could be seen.

The oxygen saturation monitor was now starting the countdown toward cardiac arrest.

Fuck.

I can't see.

I can't see anything.

I can't put it in like this.

'If it doesn't work with suction alone, use the blade like a dam! You dummy!'

Yes, I had certainly seen that comment during the training from the gallery.

'In that case, don't hesitate and just shove it in! Push all of the tongue base and blood clots to the left with the tip of the blade to make space even for a second! Do it aggressively!'

I abandoned reason.

I shoved the laryngoscope blade held in my left hand deep into the patient's mouth.

And in that state, I swept the tongue and the regurgitating blood clots entirely to the left.

"Gah!"

In an instant, the blood subsided and a space of a fleeting moment opened up.

But because of the mucosa swollen and bloated from blood, it was utterly impossible to know where the epiglottis was and where the vocal cords were.

I lost my way.

'Where is it! Where do I have to put it in!'

The numbers on the monitor were pointing to 55%.

'If you can't see, you have to press from the outside. Don't you know BURP? Tell the nurse to push the thyroid cartilage backward, upward, and to the right! Then the vocal cords will come down before your eyes!'

I snatched the hand of the nurse who was fidgeting by my side.

"Teacher! Here! The patient's neck! This protruding bone here, press it with all your might! Downward, and toward my side!"

The nurse strongly pressed the patient's neck.

It was just then.

The field of vision changed minutely.

Amidst the blood-soaked mess, the outline of the epiglottis faintly appeared, and beyond it, a V-shaped white structure was dimly visible.

Vocal cords!

Found you, you bastard!

Filled with joy, I pushed the tube held in my right hand toward that white gap. Now it is finished.

If I just put it in...

Ting.

The tip of the tube was blocked by something.

It did not go in.

"Why won't it go in!"

The worst situation.

Laryngospasm.

Oxygen saturation 50%.

Now it is finished.

'Spasm in that situation? Don't push with force. It'll tear! Keep the tip of the tube still against the vocal cords! Wait for the spasm to release with continuous pressure!'

...Yes.

It's the last hope.

Without pushing the tube in further or pulling it out, I fixed it still at the entrance of the vocal cords.

1 second, 2 seconds, 3 seconds....

The heart rate on the monitor started to slow down.

Please.

Please open.

Please.

And.

Slid.

The resistance felt at the tip of the tube disappeared like a lie.

Without missing that fleeting moment, I pushed the tube all the way in.

It's done.

It went in.

"Phew...."

Just then, at the moment I let out a sigh of relief and wiped the sweat from my forehead.

"Hey! What are you doing right now...!"

Han Jae-on, the 3rd year who hurriedly ran over pulling back the curtain, froze right there upon seeing the scene before his eyes.

A blood-soaked patient, and a 1st-year resident who had stamped a tube into that patient's mouth and was calmly performing auscultation.

Han Jae-on's pupils shook.

Han Jae-on's gaze alternated between the laryngoscope held in my hand, the tube stamped into the patient's mouth, and my blood-soaked gown.

"It burst while he suddenly coughed."

My voice did not shake.

"Because the airway was blocked by massive bleeding and the sat dropped into the 70s, I performed endotracheal intubation immediately under my judgment. A 7.5 size tube went in and cuff ballooning is finished. I just checked the breath sounds of both lungs while squeezing the Ambu bag, and there is no problem with the tube position."

The expression of Han Jae-on listening to my report changed.

And then, she snatched the stethoscope held in my hand and brought it directly to the patient's chest.

Check.

That is the senior's role.

"Breath sounds on both sides... the tube went in properly."

She muttered shortly, then immediately switched to commander mode.

"You stick right next to the patient and hold the tube so it doesn't fall out. I'll hook up the vent (*ventilator)."

And then Han Jae-on started giving instructions to the nurse.

"Pour in 1 liter of normal saline through the line currently established. Because we have to fill the volume first."

"Yes, Teacher!"

"And check right now with the blood bank if the PRBC that went out for crossmatching earlier can come down immediately."

"I'll check and let you know right away!"

"Just in case, mix a norepinephrine ampule and have one line on standby on the fluid pump. If the blood pressure drops below 80, prepare to shoot it immediately."

"Yes!"

"Please prepare an A-line (* arterial line) kit too. If the blood pressure keeps fluctuating later, we'll establish an arterial line right away."

Han Jae-on headed toward the station without looking back.

I nodded and wiped the blood that had splattered near my mouth with gauze.

I really did this.

I drove a tube into the throat of a person bleeding profusely.

It felt unrealistic.

Soon after, Han Jae-on returned dragging a heavy ventilator.

Along with a machine sound, the screen lit up. Her fingers flew over the touch screen.

With a whooshing sound, the machine started to forcibly blow oxygen into the patient's lungs.

The patient's chest rose and fell regularly.

The oxygen saturation figure crept up to 80, 85, 90... and finally to 95%.

For now, the urgent fire was put out.

Without turning around to look at me, Han Jae-on shouted toward the nurse.

"Nurse Nayeon! Call anesthesia and ENT again right now, tell them the patient burst and intubation is finished! Tell them to come down as quickly as possible!"

"Yes, Teacher!"

And then she turned back to look at me.

What is it.

"Han Hyeonjae."

"Yes."

"Go to the medicine room and bring 2 ampules of midazolam and 1 ampule of rocuronium. The patient seems to be waking up gradually, so we need to put him to sleep right away."

Only then did I come to my senses.

I ran to the emergency medicine room.

The sedative midazolam, the muscle relaxant rocuronium.

Medications that would put the patient into a deep sleep and paralyze the muscles to make him perfectly compliant with the ventilator.

While gathering the medications, the scene from a moment ago brushed past my head like slow motion.

...I really pulled this off.

A hollow laugh came out. My hands were still shaking minutely.

When I returned to the patient, Han Jae-on gestured with her head upon seeing the syringe held in my hand.

"Did you bring it? Give it all directly through the IV line."

I connected the syringe to the three-way of the fluid line connected to the patient's arm.

First, midazolam. The transparent fluid was pushed into the blood vessel. Next was rocuronium.

"Okay. Now let's fix the tube."

Han Jae-on brought over medical tape cut long.

We applied tape around the patient's mouth to firmly fix the tube so it wouldn't come out.

"Now we have to call portable X-ray to check the tube depth."

Han Jae-on's instructions had no room for a break.

I picked up the intercom and contacted the radiology department.

After a short while, the radiologic technologist came dragging the mobile X-ray machine.

And the shooting finished in no time.

Before even 1 minute passed, the X-ray picture taken just now popped up on the station monitor.

"Let's see...."

Han Jae-on and I stood side by side in front of the monitor, looking for the tip of the tube.

The tip of the tube was positioned in the proper position.

"The depth is perfectly right too."

Han Jae-on muttered quietly.

Instead of an answer, I swallowed hard.

And then Han Jae-on stepped forward herself.

Feeling for the pulse by groping the patient's wrist radial artery with her fingertips, she stabbed the syringe in without hesitation.

Arterial blood welled up and filled inside the syringe.

"Send this to the lab right away!"

The syringe containing blood was held in the nurse's hand as she ran to the lab.

Now only waiting for the results remained.

As if all the commotion that broke out was a lie, tranquility found the emergency room again.

Only the sound of the ventilator echoed regularly.

All initial measures finished. The patient became stable for now.

My hands shook and my heart shook.

Am I... am I crazy?

Really.

What is this feeling? This feeling of my heart racing for reasons unknown.

Only then did Han Jae-on shove her hands into her pockets, lean against the wall, and stare at me.

Her expression could not be read.

"Hey."

"...Yes, Teacher."

"What you just did."

Han Jae-on chose her words for a moment.

"You did fucking well."

"...Pardon?"

"How did you do it? Blood is spouting like that, yet you put it in without shaking a single hand? And alone at that?"

I could not bring myself to say, 'I was forced to preview it by ghosts a few days ago.'

The most textbook answer burst out from my mouth.

"I just did as I learned."

Han Jae-on smirked upon hearing my answer.

"Bullshit."

"If everything worked out just by doing as learned, why would there be patients leaving this world?"