CHAPTER 183: 183 RAPID DECLINE IN HEALTH CONDITION

"Banxia, thanks a lot," Wei Yuan said gratefully upon returning to the emergency room.

"Please, there’s no need for formality. Did you resect or repair?" Liu Banxia asked with a grin.

"I resected some. The delay was quite long, and he’d ingested a lot to pass the pen. I was worried about an anastomotic leak, so I created a stoma first," explained Wei Yuan.

"My patient with the fractured ankle also nearly had serious complications—gastric ulcer bleeding. Director Xiao himself performed the endoscopic hemostasis. I’m just hoping we can move to the new building soon. That would mean more equipment here, and we wouldn’t have to run around so much," Liu Banxia said.

"I hear it’s going to be high-spec. Right now, it’s the lower five floors, but the upper three floors are also reserved for the emergency center," said Wei Yuan.

"We’ll see how it turns out. The list will be announced in the next few days, and then things should get a bit easier for us," Liu Banxia remarked with a smile.

"Dr. Liu, the emergency center just called. A car accident patient, unconscious, is on the way," Wang Ying suddenly announced.

"Ah... another car accident. Brother Wei, let’s get ready," Liu Banxia sighed. If the patient was unconscious, their condition was undoubtedly severe.

Less than five minutes later, an ambulance arrived, accompanied by a police car.

"Patient is Zhang, male, 22 years old. BP 70/100, heart rate 125. Given oxygen by emergency services; became unconscious after boarding the ambulance," reported the paramedic.

"Resuscitation Room One. Liang Xiaolin, secure the airway. Dr. Wei, trauma assessment. Qing Kewa, establish IV access. Xu Dan, rapid blood panel, cross-match, and prepare two units of O-negative blood," Liu Banxia quickly instructed.

Zhou Shuwen, who had just returned from the green channel, paused. He wanted to observe Liu Banxia organizing the emergency response firsthand.

"Prepare to transfer. One, two, three, lift!" Liu Banxia commanded once they were in Resuscitation Room One.

"Diminished breath sounds in the left lung. Suspected left tibial fracture," reported Wei Yuan.

"Pupils are reactive. I’m intubating now," said Liang Xiaolin.

"Multiple external abrasions. Large abrasions on the right leg and right arm. Bring the ultrasound; let’s check the abdomen first," Liu Banxia said after a quick look.

"Abdomen’s clear. Chest... fluid in the left pleural cavity. Liang Xiaolin, perform a thoracostomy. Schedule an X-ray, and send him over directly after the tube is inserted."

The last time Liang Xiaolin performed a thoracostomy, she had hesitated. This time, she didn’t even think twice. As soon as Liu Banxia gave the order, she began the procedure.

"Blood’s here!" Xu Dan announced, running over.

"Rapid transfusion; his blood pressure is dropping. Officer, have you contacted the patient’s family yet? Any medical history?" Liu Banxia asked.

"Not yet. We haven’t found a phone or ID. We’re arranging a site search," one of the police officers replied.

"Thoracostomy complete!" Liang Xiaolin called out at that moment.

"Good. The patient’s vital signs are stabilizing. Let’s get an X-ray first, then schedule a head CT scan," Liu Banxia instructed.

Zhou Shuwen nodded. He was quite satisfied with the management of this admission.

Emergency admissions needed to be orderly, without panic. There were many things to do simultaneously, and Liu Banxia had no issues with delegation. Crucially, the coordination of the others was seamless, proving this small team was functioning very well.

Liu Banxia didn’t stay idle; he went directly to the X-ray room with them. He needed to make an initial assessment: whether the patient required immediate transfer to the operating room.

"Bilateral rib fractures, bilateral pulmonary contusions, atelectasis of the left upper lobe," Dr. Wu Bo from Radiology diagnosed.

Liu Banxia checked the patient’s oxygen saturation again; it was now 100%. His vital signs had also returned to normal.

"Do we still need to notify the operating room?" Liang Xiaolin asked.

Liu Banxia shook his head. "The bleeding should have stopped. Let’s stick with conservative treatment for now. Take him for a head CT, and then a bronchoscopy to see if the atelectasis is due to a blood clot obstructing the airway."

"He’s quite lucky; his left leg is in that state, yet it’s not fractured. I’ll head back to the ER to talk with the police. You monitor this patient."

Liang Xiaolin nodded. This was a victim of a hit-and-run; there was a lot of paperwork to handle.

"You did very well today. The thoracostomy was quick and perfect," Liu Banxia praised as he was about to leave.

Liang Xiaolin was taken aback, her expression turning joyful. It only just occurred to her that she had completed the thoracostomy today without a second thought.

"How’s he doing?" Wei Yuan asked when Liu Banxia returned to the emergency department.

"The bleeding should be fine. Bilateral rib fractures, bilateral pulmonary contusions. The most severe injury is the atelectasis of the left upper lobe. After the CT, he’ll have a bronchoscopy. We’ll decide after we get the results," Liu Banxia said.

"I just heard from the police that they think they’ve identified the vehicle involved, but they still haven’t found contact information for the patient’s relatives," Wei Yuan said.

"Sigh, I need to go get the director’s signature," Liu Banxia stated. The necessary emergency treatment was complete for now, and the required paperwork had to be filled out. He was the chief resident, true, but he didn’t have that much authority.

"Put it down. You did very well today. Just hang in there a bit longer. We’re also pushing the construction company to finish as soon as possible," Zhou Shuwen said with implicit praise as Liu Banxia walked in.

"Thank you, Director. I’ll head out then," Liu Banxia said, delighted.

Liang Xiaolin needed validation, and so did he. Gaining Zhou Shuwen’s approval was even harder. Even as Zhou Shuwen’s student, he was constantly on edge, afraid his performance wouldn’t meet Zhou Shuwen’s standards.

Although it was lunchtime, Liu Banxia could only let Wei Yuan eat first. He had to wait for the latest test results for the recent patient. It could be said that the patient wasn’t truly out of danger yet. Even though his vital signs had returned to normal, pulmonary atelectasis was a condition not to be underestimated.

"He really is quite lucky. The head CT scan is normal. The bronchoscopy didn’t find any blood clots either. So, the atelectasis is probably due to the pulmonary contusion? What’s next?" Liang Xiaolin asked after the examinations.

"We have no choice but to consult cardiology, cardiothoracic surgery, and orthopedics. Whether he can have surgery is their decision; it’s beyond my scope," Liu Banxia replied.

Although it wasn’t a case of one call summoning an army, specialists from these three departments arrived swiftly. What frustrated Liu Banxia somewhat was that the cardiothoracic surgeon who came was Chen Xuehai again.

"Well, everyone, what do you think?" Liu Banxia asked after they had examined the patient.

"I’ll go first," said Wu Mingyu, the attending from Orthopedics. "The rib fractures aren’t a major issue. They can be dealt with after the pulmonary problems are resolved."

"Although there’s some atelectasis, the indications for surgery aren’t very clear right now. I also personally recommend conservative treatment. Dr. Xu, what are your thoughts?" Chen Xuehai asked.

Xu Guosheng, the attending from Cardiology, nodded. "Let’s observe for now. What’s his current oxygen flow rate?"

"Current oxygen supply is 60%, SpO2 is 100%. He’s relatively stable," Liu Banxia quickly replied.

"Alright, let’s keep him on your service for now. Monitor closely. If his SpO2 drops to 95, administer a bronchodilator. Other indicators aren’t very clear, so we’ll have to observe," Xu Guosheng said with a smile.

"Dr. Xu, thank you so much. This will be great experience for our nurses here," Liu Banxia said quickly.

"It’s best to arrange for someone to monitor him continuously," Xu Guosheng nodded.

PING! Daily Mission Completed (3/20).

Consultation completed. Gained 50 Experience Points, 30 Diagnostics Skill Proficiency.

Congratulations to Host for advancing to Level 34 (58,967/62,084)! Gained 1 Attribute Point, 5 Glory Points.

Liu Banxia carefully checked the patient’s condition again, gave instructions to the nurse, and then went downstairs.

"You take them to eat. I’ll watch things here," Wei Yuan said.

"Brother Wei, sorry to trouble you. It’s mainly that car accident patient; his ventilator is already at 60%. I’ve briefed the nurse," Liu Banxia said.

Wei Yuan nodded. "Go eat. Isn’t your friend’s child having surgery? If you have time, go check on them."

"I doubt I’ll manage. I need to keep a constant watch on the patient we just admitted. Today seemed uneventful, but all three patients turned out to be in dangerous situations," Liu Banxia said with a wry smile.

On the way to the cafeteria, he called Qiu Huaili. He wouldn’t be able to be there for the little one’s surgery. His own patient’s life was at risk; that was the priority.

"By the way, Qing Kewa, where in Russia are you from?" Liu Banxia asked curiously during lunch.

"Vladivostok. It’s very close to China and was known by another name in the past. But I’ve never traveled to China from there. The city I’ve visited most is Harbin," Qing Kewa said.

"Actually, even if you told me, I wouldn’t really understand, hahaha..." Liu Banxia started seriously, then couldn’t help but laugh.

Qing Kewa gave him an amused look. "It took a lot of courage for me to come to China to study. But it’s really great here, so much delicious food. When are we going for barbecue again?"

"That’ll have to wait. Dr. Shi will send over the iron griddle we used before tonight. Reheating the food on it won’t make it taste much different," Liu Banxia said.

"Then I’ll have to eat a lot!" Qing Kewa said delightedly.

Just as she finished speaking, Liu Banxia’s phone rang.

"Xu Dan, is there a problem in the ward?" Liu Banxia asked after answering.

"Dr. Liu, the car accident patient’s oxygen saturation is dropping rapidly! It’s at 95 now. Should we use a bronchodilator or increase the ventilator’s oxygen supply?" Xu Dan asked hastily.

"Increase the oxygen supply to 70% first. I’m on my way now!" Liu Banxia said and started running towards the emergency department.

He hadn’t expected the patient’s condition to deteriorate so quickly. How long had it been since the consultation ended? Not even twenty minutes. He’d only had a few bites of his meal.

Judging by the current situation, this patient wasn’t far from a critical period. That was his internal assessment.