CHAPTER 488: 488 SUDDEN CARDIAC TAMPONADE

(Thanks to Shui Mi, mochax2, mangmangliu, Crushed Sorrow, Wolf Sky W, and Lazy Lost Bug for the monthly ticket encouragement)

"Pay attention, everyone. It’s been a long time since we’ve had a formal morning meeting. We’re not that busy today, so we should have a little chat."

Early the next morning, before making rounds, Liu Banxia gathered everyone.

"This is also to remind everyone: you must be extremely cautious when admitting patients with acute abdominal pain or chest pain," Liu Banxia continued.

"Among the patients admitted yesterday, one of our colleagues had a near miss. This isn’t about naming and shaming; this place is small enough that everyone knows what happened."

"I spoke with Dr. Shi about this yesterday. Right now, you still have the chance to make mistakes. But once you officially become resident doctors, we won’t have as much time to keep an eye on you."

"This topic is endless; if you’re interested, you can ask Dr. Shi for more information later. Now, back to our cases. Besides the unpredictable emergency patients with collision and fall injuries, there were two other cases yesterday."

"One was the patient who coughed so hard he damaged his lungs. He should be able to have follow-up tests today to determine if it’s asthma. The other was the young lady who loves bubble tea, diagnosed with hyperlipidemic severe acute pancreatitis."

"Just from its name, laden with qualifiers, you can tell this disease can be life-threatening. If Liu Yiqing hadn’t been more thorough yesterday and ordered blood chemistry tests for the patient, instead of just a simple CBC, can you imagine what might have happened?"

"If it were up to me, I would still provide symptomatic emergency treatment. Then the patient’s abdominal pain wouldn’t be relieved, the acute pancreatitis would worsen, and eventually, it would affect the surrounding organs."

"At that point, realizing something was gravely wrong, we would have transferred the patient to the ICU. Only after a comprehensive examination in the ICU would we discover what was really going on."

"I’m not saying you should run blood chemistry on every patient with abdominal pain. You must use your clinical judgment and make appropriate choices based on each patient’s specific condition."

"I’ll say it again: be extra vigilant with patients complaining of acute abdominal pain or chest pain. The faster we diagnose, the more time we can buy for our patients."

"Alright, that will be all for today. The Director will be back at work today. Don’t worry, I’ll be sure to praise all of you when I report on our work."

Seeing his gleaming white teeth, all the interns shivered in unison. One couldn’t take this arch-fiend’s words at face value. Who knew when he might be speaking ironically? He was a capricious arch-fiend; if you took him seriously, you’d lose.

It had indeed been quite some time since they had a morning meeting like this, as there were far too many patients coming and going in the emergency center.

Liu Banxia’s usual approach was to utilize any spare moment—perhaps during a lull in consultations or while eating—to have everyone discuss newly admitted cases.

Moreover, all doctors and interns in the emergency center were currently on duty, prepared for any major emergencies, which actually made patient handovers smoother.

Of course, this was only temporary. The interns were focused on learning, so sacrificing rest wasn’t an issue for now. People like Wei Yuan were also invested in the emergency center; after all, it was tied to everyone’s future livelihood.

This intense approach was manageable short-term, but if they continued this way indefinitely, everyone would eventually burn out.

People aren’t machines, where better oil means less wear and tear. Even machines need maintenance and rest, don’t they?

After the morning meeting, Liu Banxia leisurely strolled upstairs to Tang Feifei’s ward.

When he entered, Tang Feifei had already changed into the clothes she was wearing when she first came for treatment.

"Looks like you can’t wait to leave. Congratulations on overcoming your illness. Go home and have a peaceful New Year. Is anyone picking you up?" Liu Banxia asked.

"Yes, Qiaoqiao is coming to get me. Hehe, I don’t need to be formal with Qiaoqiao," Tang Feifei said happily.

"You two are really incredible. You’ve only known each other for such a short time, yet you’re as close as if you’ve known each other for years. Whatever, I won’t meddle. Just have Qiaoqiao handle your discharge procedures," Liu Banxia said.

"Do you guys have time to visit Beijing? Come find me when you’re there," Tang Feifei asked.

"I can’t even think about taking time off, let alone having some quality time with Qiaoqiao at home. I probably won’t get a decent break until the emergency center is truly running smoothly," Liu Banxia sighed, shaking his head.

"When you go back, please be mindful; don’t let my words go in one ear and out the other. I don’t want to go through the trouble of diagnosing you all over again."

"Well, if I feel unwell next time, I’ll still come to you. You’re so skilled; you really should consider developing your career in Beijing," Tang Feifei said.

"I have several senior classmates in Beijing; it’s not all that different. No matter where you are, the work is the same," Liu Banxia said.

"Alright, I’m going to take off now; you wait here. My parents are coming, and Qiaoqiao might not be able to get away early. Don’t forget the medical advice I gave you; it’s important."

Tang Feifei stuck her tongue out, understanding what Liu Banxia meant. She was torn now; she really wanted that role—it was an award-winning part!

Liu Banxia didn’t press further. There were too many non-compliant patients. While in the hospital, they took the doctor’s words seriously, but once they felt better, many tended to let the advice go in one ear and out the other.

"Oh, Director, you’re here! Any instructions?"

As soon as he returned to the first floor, he saw Zhou Shuwen’s office door open and hurried in.

"What instructions could there be? Do you only feel happy when I praise you?" Zhou Shuwen asked, smiling.

"Not at all!" Liu Banxia said quickly.

"Now that you’re back, I can finally relax a bit. I was losing sleep every night, worried we might encounter a major crisis. Xu Yino, Liu Yiqing, and Su Wenhao have already agreed to stay with us in the emergency center."

Zhou Shuwen nodded. "That’s good news. We need to focus more on their training. You’ve heard about my promotion to Deputy Chief Director, right? It will be publicly announced after the New Year."

"Hehe, I heard about it, though it’s a bit late; I only heard about this yesterday," Liu Banxia said, grinning.

"Alright, go back to work. You’ve done really well recently. After the New Year, our hospital should be able to bring in a new batch of doctors, which will also help support our emergency center," Zhou Shuwen said.

"So you went out to recruit people?" Liu Banxia asked, pleasantly surprised.

Zhou Shuwen shot him an exasperated look. "What else would I be doing out there for so long? These exchanges are also opportunities to discover and attract talent."

"Stop pestering me and get to work. I can’t be bothered with these trivial matters. I’m quite tired from running around these past few days, so you’ll need to take on more responsibility."

"Then I’ll head out first. Call me if you need anything. Actually, there aren’t that many patients now, so everyone can relax a little," Liu Banxia said, then sauntered out.

In his office, Zhou Shuwen shook his head helplessly. He hadn’t told Liu Banxia about his promotion to Deputy Chief Director earlier because he was worried Liu Banxia might become too ostentatious. He couldn’t quite figure Liu Banxia out. He was a clever apprentice, but also a very troublesome one.

Just as Liu Banxia stepped out, he saw Wang Huan waving at him and happily went over.

"Given your expertise in internal medicine, help me with a consult," Wang Huan said.

"The patient came in this morning due to dyspnea. I performed an auscultation and a brief physical examination. I had just ordered a chest X-ray for the patient when he suddenly exhibited severe respiratory distress."

"I’ve taken blood samples for a CBC and blood chemistry, and I’ve also ordered a chest CT scan for a more accurate assessment."

"What baffles me is that communication with the patient during the physical exam was smooth, but then his condition suddenly deteriorated."

"If it were simple inflammation, it shouldn’t have progressed like this. I almost intubated him on the spot. Fortunately, using an Ambu bag significantly improved his condition, so he could proceed to the CT scan."

"This case is indeed challenging. He came in for a routine visit and nearly became an emergency intubation... but..."

BEEP. BEEP. BEEP.

The emergency center’s alarm suddenly blared, interrupting Wang Huan.

This alarm indicated a patient was in critical condition with no doctors immediately available to assist.

Liu Banxia checked. The alarm had been triggered in the CT scan room, which startled him. He grabbed a pair of disposable gloves, pulling them on as he ran.

When he reached the CT room, he saw a male patient lying there while Xu Yino performed an auscultation.

"What’s the situation?" Liu Banxia asked.

"Teacher Liu, the patient is pale, with a rapid heart rate, muffled heart sounds, distended jugular veins, and difficulty breathing. I suspect cardiac tamponade," Xu Yino reported hastily.

Liu Banxia’s brow furrowed. "Get a large-gauge syringe and needle. We need to perform an on-site pericardiocentesis."

Xu Yino was momentarily stunned but still ran to the emergency cart, found a large-gauge syringe and needle, and handed them to Liu Banxia.

Normally, pericardiocentesis must be performed under sterile conditions. Furthermore, imaging studies are typically required beforehand to determine the heart’s position and size.

However, Liu Banxia currently had no diagnostic data to rely on; he could only go by feel.

Moreover, due to the cardiac tamponade, the patient’s heartbeat had already slowed significantly, making it extremely difficult to palpate accurately.

The slightest misjudgment could puncture the heart. Even if performed as an emergency life-saving measure, it would still constitute a medical incident, though his culpability might be lessened.

It wasn’t just Xu Yino who was tense; the surrounding patients and their families were also on edge, watching as the long needle was positioned over the patient’s chest. If he thrusts it in like that, wouldn’t it kill the man outright?