This doctor is already middle-aged, and he's only just started practicing medicine.

Chapter 225 An Ran's First Night Shift!

Across from Lu Cheng, Liang Jianhong remained silent, still staring in disbelief.

Lu Cheng removed his hand from the patient's abdomen: "Dr. Liang, I don't think we can clean the hematoma on-site. Let's go into the operating room first. What do you think?"

Lu Cheng asked Liang Jianhong again.

Fortunately, Lu Cheng had previously worked under Liang Jianhong, so Liang Jianhong knew how "terrifying" Lu Cheng was. His thoughts were broken by Lu Cheng's voice: "Oh, okay!"

Liang Jianhong didn't even dare to open Lu Cheng's abdomen, because this kind of emergency hemostasis was not something he had considered taking on in recent years.

Most people in the department always think of calling for backup when they are on duty, rather than taking action themselves.

Therefore, even if Lu Cheng doesn't do a good job, Liang Jianhong can't bail him out.

According to Liang Jianhong's initial assessment, the patient's mortality rate was over 80%, and all current rescue measures were palliative.

This is also the main reason why Deng Duanmou went to talk to the patient's family as soon as possible.

Dr. Dai Jinzhong, the head of the internal medicine department, finally completed the local auscultation: "Currently, the cardiopulmonary function is acceptable, but the main problem is still arterial blood loss."

Dai Jinzhong is the deputy chief physician in the department. Although he is in the internal medicine group, he is also Liang Jianhong's superior: "Director Dai, we have already called the vascular surgery and general surgery departments."

"The airway is clear," Guo Lili, who was temporarily assisting, reported.

Dai Jinzhong also didn't have a good solution for the time being: "Continue to monitor blood oxygen and notify the blood bank to bring blood as soon as possible."

"Have the blood type results been obtained yet?"

"Not yet! The blood pressure is too low, we can't get any blood," a nurse replied.

"Even if we don't get a ticket, we need to figure something out quickly." Dai Jinzhong hung the stethoscope around his neck.

The most important vital signs for an emergency patient are blood pressure, heart rate, blood oxygen, and respiration.

The patient's heart and lungs are fine; the main cause is currently hemorrhagic shock and low blood pressure.

While medication can raise blood pressure, blood volume must be replenished as quickly as possible.

If there are no problems with the respiratory tract, the most important thing to pay attention to now is the arrhythmia caused by low blood pressure, the root cause of which is still blood volume.

Somewhat worried, Dai Jinzhong glanced at the patient's abdomen. The incision Lu Cheng had made wasn't large, and the field of vision wasn't very good, so all Dai Jinzhong could see were the ends of the two hemostatic forceps and the hematoma inside the abdomen.

He had no way of checking whether the bleeding had stopped properly or whether it met the standards.

"The intravenous access has been established," an experienced nurse reported.

"Immediately increase blood volume. Continue establishing other intravenous access lines; we'll need dual-line transfusions later," Dai Jinzhong continued, issuing orders.

"This patient has low blood pressure, so establishing an intravenous line will be a bit difficult." The nurse wasn't very willing.

"We have to find a way, even if it's difficult, otherwise he can't afford to drag this out!"

As Dai Jinzhong was speaking, Xiao Zhaoxi, who had rushed over upon hearing the news, hurriedly ran in, already quickly putting on gloves: "What's going on?"

Liang Jianhong said, "There is an active hematoma in the abdomen, and the patient is already in shock."

"We made an emergency abdominal incision, and Xiao Lu immediately tried to stop the bleeding with instruments, but the effect is still difficult to judge."

Xiao Zhaoxi nodded upon hearing this, glanced at Lu Cheng, and immediately approached the patient.

It's definitely better for Lu Cheng to have the idea to take a gamble than to leave the abdominal incision untreated.

This is an abdominal hematoma, and exploratory laparotomy is necessary. An intra-abdominal hematoma is not the same as a pelvic hematoma; opening the abdomen prematurely will worsen the bleeding.

Even without opening the abdominal cavity, a hematoma in the abdomen can still cause the patient to die from shock.

Xiao Zhaoxi didn't even have time to put on protective clothing; she just barged in wearing a white coat.

Because it's an emergency room, it's also equipped with a negative pressure suction device, although it's used for suctioning phlegm and isn't completely sterile.

However, nowadays, if the patient's bleeding point cannot be found, shock can be fatal, so Xiao Zhaoxi can no longer disregard extreme aseptic principles.

I picked up the negative pressure suction device and began to clean the hematoma.

After about thirty seconds of cleaning, Xiao Zhaoxi could barely see the inside of his abdomen.

After the remaining blood was cleaned up, no more blood spurted out. There might still be some seepage, but the amount of blood loss from seepage was negligible compared to the total blood loss. This required a delicate hemostasis procedure performed in the operating room.

In other words, Lu Cheng had already taken care of the hemostasis procedures that needed to be performed in the emergency room before Lu Cheng arrived.

This is completely different from the "nepotism" label that Xiao Zhaoxi gave to Lu Cheng.

The "connection master" for Lu Cheng was himself; it was Mu Leng who had put in a good word for him. Therefore, Xiao Zhaoxi's expectations of Lu Cheng's abilities were not too unreasonable.

Lu Cheng didn't follow the general principle of "connections," and went a bit too far.

"Make another call to urge for a consultation. Send the patient to the CT room first," Xiao Zhaoxi ordered.

Dai Jinzhong hesitated for a moment: "Director Xiao, this patient has lost a lot of blood."

“If the blood loss is severe, blood transfusion and blood volume expansion must be performed in time after the bleeding is stopped. Once the bleeding has been stopped, the patient can be transferred by flatbed cart without increasing the risk.”

"Next, we need to make an accurate diagnosis. We must process any data that can aid in the diagnosis. What have I been telling you all along?" Xiao Zhaoxi's voice was serious.

“Yes.” Dai Jinzhong lowered his head and offered no further suggestions.

But his gaze fell on Lu Cheng.

Although Xiao Zhaoxi is the director and a bit domineering, he is not an unreasonable person. There must be a reason why Xiao Zhaoxi can be so assertive.

The core reason is that the hemostasis was too fast and too effective, so effective that Xiao Zhaoxi had no room to find any shortcomings.

Lu Cheng was a stranger, a newcomer whom even Dai Jinzhong didn't recognize.

They are quite capable.

As the on-call internal medicine doctor in the emergency room, Dai Jinzhong certainly didn't need to personally push the patient around.

Liang Jianhong and Lu Cheng had already set off with their team in a tense atmosphere. The nursing team carried portable oxygen pillows and also moved the monitors onto the stretcher.

The group hurriedly pushed the gurney towards the CT room outside the emergency room.

This type of emergency is classified as an ultra-urgent case. Medical staff lead the team and have the right to cut in line at any emergency CT room, only waiting for patients to be examined inside.

……

After the group left, Dai Jinzhong thought for a moment and asked, "Director Xiao, is this Lu Cheng someone who was recently selected from the surgery department? He seems very smart and quick-witted."

Xiao Zhaoxi nodded: "Yes, I just joined the department today."

"We've gotten a lucky break. We haven't fully assessed their specific abilities yet, but we can be sure that they're above average for their age and job level."

Lu Cheng is not the main character.

Even though Xiao Zhaoxi and Mu Leng were related, and Lu Cheng was considered a junior, Xiao Zhaoxi still received very little attention from Lu Cheng.

All he knew was that Lu Cheng had won a prize in a microscopic skills competition, but he didn't care what level it was.

Microsurgery is microsurgery, and emergency medicine is emergency medicine; it's just icing on the cake.

Of course, capable people are more likely to have their strengths recognized.

Lu Cheng's strengths were gradually revealed.

Guo Lili, a colleague in internal medicine, was more concerned about Lu Cheng: "Director, Lu Cheng is the top scorer in the surgical written exam, and it seems that he is also the top scorer overall."

"She must be a top student."

Dai Jinzhong said, "Once you're already working, the term 'academic superstar' is no longer appropriate. In our clinical work, those who are particularly capable are called skilled workers, experienced workers, team leaders, or bosses."

"We all follow Director Xiao to beg for food."

Guo Lili looked at Dai Jinzhong with confusion, not quite understanding what Dai Jinzhong was saying. Just as Dai Jinzhong was about to say something more...

Xiao Zhaoxi said, "Let's not talk about the past. I said we're going to loosen control over the internal medicine department. From now on, it will all be handled by Director Wu. Don't expect me to clean up your messes anymore."

"I don't have that much energy."

After exchanging pleasantries, Xiao Zhaoxi finally asked Lu Cheng, "Lu, how are you so sure the damaged blood vessel is the splenic artery?"

Lu Cheng shook his head: "Blunt abdominal trauma is a non-open trauma. Given the history of trauma, it is highly unlikely to be aortic dissection or a ruptured aneurysm."

"The probability of the index finger organ rupture is relatively high."

"There are relatively more causes of shock due to delayed splenic rupture."

Xiao Zhaoxi nodded slowly: "You have a very sharp mind, and your clinical reasoning is also quite clear!"

"What about shock without a history of external injury?"

Lu Cheng could tell that Xiao Zhaoxi was testing him: "Unexplained shock that is not caused by external injury requires consideration of aneurysm rupture, aortic dissection, cardiac perforation, etc."

"We'll have to wait for a consultation."

This is currently beyond Lu Cheng's capabilities.

Emergency surgeries in cardiac and vascular surgery are not something Lu Cheng can master in a short period of time.

“He’s an expert. Congratulations, Director Xiao.” Dai Jinzhong asked Xiao Zhaoxi very directly.

Xiao Zhaoxi shook his head: "In our emergency department, being knowledgeable isn't necessarily a good thing; it can easily lead to trouble and disputes."

After confirming that no patients' family members were present and that the internal medicine patients in the emergency room had been transferred to the ICU, Xiao Zhaoxi said, "Sometimes, if we do our duty, we are not responsible; but if we do things outside our duty, we may get into trouble." "I once heard a professor from the emergency department of Xiangya Hospital say this: Emergency room doctors should only show three-tenths of their full abilities."

"Aim not for merit, but for no fault."

"I would actually recommend that Xiao Lu and Liang Jianhong have an exploratory laparotomy done and then wait for the specialist to arrive."

Xiao Zhaoxi's words, which were a mix of admonition and guidance, were the most practical.

Dai Jinzhong did not answer, but said, "Director Xiao, let's go see the CT scan together."

The patient's CT scan images can be accessed in the image reading system after the CT scan is completed, but there is no imaging report.

By the time the group moved to the computer, the CT scan results were already available.

After taking a look and finding no malignant lesions such as aortic dissection, Xiao Zhaoxi and the others breathed a sigh of relief: "It is indeed a relatively pure splenic rupture."

"Then the hepatobiliary surgeons can remove it."

Lu Cheng bit his lip, but still didn't say anything about trying to save his spleen or spleen.

What Xiao Zhaoxi just said was a suggestion.

The more you do, the more mistakes you make; the less you do, the fewer mistakes you make; and if you do nothing, you make no

Clinical practice is a large society with its own established rules of operation. Lu Cheng is far from being able to defy the rules and make them give way to him, so let's not create unnecessary trouble.

This patient is fortunate to have survived and to be treated according to the most important emergency measures currently available.

Opening the abdomen to stop the bleeding is an emergency measure, and regardless of how well or poorly Lu Cheng performed it, he bears no responsibility.

After all, doing nothing means certain death.

People from the hepatobiliary surgery and general surgery departments arrived, and the patient was quickly led into the operating room by the hepatobiliary surgeons.

Deng Duanmou also conveniently obtained the signed document:

"Director Xiao, the patient's family has already signed the consent form and paid the fees, but so far only 10,000 yuan has been paid."

"That's enough for now. We can pay the rest later."

"Liang Jianhong, write a complete emergency resuscitation record, including laparotomy procedures and indications in the resuscitation room."

Liang Jianhong nodded: "Okay!"

“Write it truthfully. Lu Cheng is an employee of this hospital. The evening shift schedule has already been arranged, and his practice license registration in the medical affairs department has been completed,” Xiao Zhaoxi instructed.

After giving his instructions, Deng Duanmou returned to his ward to continue writing the medical records, while Xiao Zhaoxi led Lu Cheng back to the director's office.

"Director Xiao, weren't you in the general consultation? Have you finished yours?" Lu Cheng asked.

“That was just the central ICU calling in extra people to avoid responsibility. What can I do in the ICU? They can do everything I can do.” Xiao Zhaoxi shook his head.

Xiao Zhaoxi immediately shifted the topic to the rescue that had just taken place: "You're quite capable! You can even stop bleeding blindly."

Xiao Zhaoxi could see the details: when Lu Cheng was stopping the bleeding, he had not completely exposed the splenic vascular system.

Lu Cheng nodded: "When I was at Longxian People's Hospital before, a professor from Xiangya No. 2 Hospital came to the countryside and told me that there were teachers who could perform blind visual hemostasis."

"My sense of touch is quite sensitive during physical examinations, so I can feel the direction of turbulence and can roughly guess which blood vessel is bleeding."

Xiao Zhaoxi also knew about this ability and nodded: "It's a gift from God, and no one else can learn this ability."

"It's okay, you did a great job, but I don't recommend you do this every time." Xiao Zhaoxi's tone was somewhat cold.

Lu Cheng looked puzzled.

Xiao Zhaoxi said, "If you can't guarantee that stopping the bleeding will be 100% successful every time, and you don't have a backup plan in case it fails, then you shouldn't rush into this operation."

"Currently in clinical practice, there is no such procedure as public recommendation; it is a matter of personal authorization from an associate professor!"

"There's no way to publicly promote it, since many people can't learn this technique. If we do, we'll just put even more clinicians in a difficult position."

"It can only be said that only a small number of highly capable people can do things that are not prohibited."

Lu Cheng nodded and said, "Okay, Director Xiao."

Xiao Zhaoxi's attitude is somewhat similar to Du Qiang's. As a doctor, you first need to ensure that your white coat is not taken off, and you need to rely on it to make a living, rather than promoting personal heroism.

A medical dispute can wipe out decades of your learning.

There is no law requiring emergency room doctors to be able to perform blind hemostasis.

Active hematoma caused by open trauma can result in death without liability.

"What were your main tasks when you were at Longxian People's Hospital?" Xiao Zhaoxi asked again.

"Director Xiao, apart from tendon injury, spleen rupture, and gallstones, the others are all routine referrals."

“For example, aortic dissection, gastrointestinal perforation, and cholangitis are all cases that require referral,” Lu Cheng replied.

In clinical emergency departments, most cases are relatively common. The rare emergency cases shown in TV dramas are rare cases published by hospitals worldwide, and they are rarely seen in reality.

Now, fewer light bulbs are being removed from the mouth.

Those who take the rugby ball below are almost extinct.

"Yes, in our hospital, apart from debridement and suturing, all other cases require referral to a specialist, including tendon injuries. Do you understand?" Xiao Zhaoxi asked.

Lu Cheng smiled and said, "Director Xiao, since the specialists can handle it, we should definitely hand it over to them truthfully."

Xiao Zhaoxi understood Lu Cheng's implied meaning, thought about it carefully for a moment, and then said, "Xiao Shu told me about your thoughts."

"If you really can't stand being idle, you can choose a rarer disease that specialists don't deal with."

"I found a few related to you myself."

"These are all sub-emergency cases."

“One is a closed Achilles tendon rupture, and the other is a joint dislocation,” Xiao Zhaoxi said.

Lu Cheng replied, "Thank you, Director Xiao."

"Doesn't our hospital have an orthopedics department? Why isn't the joint dislocation being treated?"

Xiao Zhaoxi said, "It's not that we don't want to treat it, but we think it's too troublesome to handle. We usually send the patient to a traditional Chinese medicine hospital to avoid any complications, or we suggest that the patient undergo surgery to reposition the tumor."

"Of course, you can also request a consultation for more classic joint dislocations."

"Why don't you go out and familiarize yourself with our hospital's medical record and prescription system first? You've only just joined the department, so you'll have to learn these things gradually."

Lu Cheng nodded, took his leave, and departed.

As dinner time approached, Lu Cheng approached Xiao Zhaoxi to ask what he wanted to eat for dinner. Xiao Zhaoxi had already ordered takeout and told Lu Cheng to just wait and eat.

After lunch, Xiao Zhaoxi went into the doctors' lounge, lay down, and fell asleep immediately.

He was on the second shift, handling emergency consultations, so he didn't have to be on call like an internist.

Lu Cheng stayed in the emergency room for a while and noticed that most of the patients coming to the emergency room were internal medicine-related emergencies.

For example, carbon monoxide poisoning, snake bites, dog bites...

Lu Cheng's job was to treat the dog bite wound by thoroughly cleaning it, rinsing it with hydrogen peroxide, and suturing it.

Other conditions, such as myocardial infarction, angina pectoris, and pulmonary embolism, are the most common diseases in the emergency room.

Internal medicine doctors have to sit in office for long hours.

After midnight, Chen Changlin, the deputy chief physician on night duty in the internal medicine department, told Lu Cheng to go and rest first, and that he would call if there were any patients with major injuries.

Lu Chengyi didn't hold back.

Lu Cheng didn't go into the rest room; instead, he went to the small rest room in the emergency room and fell asleep on a reclining chair.

The hospital has air conditioning in winter, so Lu Cheng doesn't feel cold even without a blanket.

When Lu Cheng woke up, it was already 6:30.

When I came out of the break room, the internal medicine team was still trying to save a patient who had suffered a myocardial infarction...

Seeing that everything was alright, Lu Cheng left the emergency room and went to the surgical clinic.

The doctor on duty in the surgical clinic was from the orthopedic emergency department. He was dozing off even though there were no patients at the moment, probably because he hadn't slept all night.

In the internal medicine clinic, long lines of patients with coughs and colds had formed.

These are all patients with common colds who were diagnosed at the fever clinic and found to have no infectious diseases; some have diarrhea, some have difficulty defecating...

Lu Cheng's first day on duty was even a bit leisurely.

In fact, after Lu Cheng took over from his elder brother Cao Gui, the feedback he received was that he was 'leisurely'!
Otherwise, Xiao Zhaoxi wouldn't have dared to schedule the night shift in the emergency room on Lu Cheng's very first day of work.

The department dared not schedule a night shift in the emergency room followed by a day shift in the ward, which was an abnormal arrangement.

Around 8 o'clock, after finishing his shift, Lu Cheng saw someone presenting him with a banner.

It was the wife of the patient whose spleen ruptured yesterday. Since Liang Jianhong, who was on duty, wasn't there, she went straight to Xiao Zhaoxi. Xiao Zhaoxi treated her politely but didn't mention that Lu Cheng had completed the core resuscitation...

Of course, Xiao Zhaoxi did not accept the banner, but instead asked her to return it, which surprised Lu Cheng slightly.

(End of this chapter)