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

Is Chapter 251 meaningful?!
"Dr. Lu, we have a new patient. They're in the wound cleaning room next door. Are you done here?"

When Du Yali, a nurse in the emergency room, ran to the door of the No. 1 debridement room and called out to Lu Cheng, she found that Lu Cheng was already bandaging the patient inside.

She quickly corrected herself, "Have you finished dealing with things here?"

"Hmm, the wound is relatively simple. The patient next door isn't bleeding much, is he?" Lu Cheng carefully bandaged the wound without turning around.

Du Yali shook her head: "Not much. Dr. Lin from the surgical clinic said it can be treated in the debridement room."

"It just rained lightly outside, and the ice has thickened, so there have been quite a few patients who slipped and fell while riding their bikes," Du Yali explained.

Lu Cheng explained, "As long as the bleeding isn't too heavy, it's fine. I'll come over as soon as I finish writing the procedure record and post-operative instructions. Please ask the other patient to wait a little while."

After Du Yali left, the delivery guy who had been bandaged by Lu Cheng said, "The weather outside today is really weird. It was fine during the day."

Lu Cheng said, "When I checked the weather forecast this afternoon, I saw that there would be a sharp drop in temperature. It's okay now, but if it snows, there will be even more patients with fractures and injuries."

"Brother, that's enough. Your wound is quite deep. Go out later to get a tetanus shot and an antibiotic injection. You can get the rest of the injections back in your hometown. Anyway, you should be able to make it in time for the New Year."

Happy New Year!

After Lu Cheng attached the sterile cotton pad, he began to clean the wound cleaning table, emptying the cotton balls and blood-stained gauze from the curved tray into the yellow trash can.

"I originally planned to make more money before the Chinese New Year by charging a higher price per order. But I still lost money today."

"I knew I shouldn't have run this route." The rider sighed, then added, "Well, it's good to get home early, after all, it's almost Chinese New Year."

"Yes, it's almost Chinese New Year." After Lu Cheng checked the instruments in the wound cleaning kit, packed them with a sheet, and put them into the sterilization box, he took off his gloves.

While writing the operation log, he looked up at the clock hanging on the wall: "It's past midnight, it's already the 29th of the twelfth lunar month."

"It seems like our family is celebrating Chinese New Year today."

The deliveryman said, "Then you can go home right after you finish work, right?"

"Brother, wait a moment, I'll finish writing this and then help you get dressed." After instructing him, Lu Cheng said, "No, I have a day shift in the ward after my night shift. I also have a night shift in the ward tomorrow, so I can't go back until the morning of the first day of the lunar new year."

The deliveryman was stunned: "Huh? Is it that bad? Twenty-four hours straight without a break?"

"The shifts are arranged like this, it's either my bad luck or someone else's bad luck. I was assigned to the holiday day during Chinese New Year, but I can't get a shift at other times."

"This is what the emergency room is like." Lu Cheng's writing speed wasn't slow, but when it came to writing serious matters, he couldn't write quickly at all.

Four or five minutes later, Lu Cheng finished writing everything, handed the medical record to the deliveryman, and helped him put on the half-length inner sweater with the sleeves cut off: "Brother, you'll definitely be a bit cold going out like this. You can't ride a bike. You'd better have someone pick you up or take a taxi home."

"After you leave here, go to Dr. Lin's surgical clinic and ask him to prescribe an IV drip and a tetanus shot for you. Then go to the nurses' station to get the injection. After that, you can go to the nearest community hospital next time!"

"Okay, Dr. Lu. Thank you." The deliveryman said as he left.

He injured his left forearm because he was wearing a tight-fitting thermal undershirt and sweater while delivering food, and a section of the sleeve was cut off. Fortunately, he was wearing a loose down jacket, so the cut inside wasn't visible from the outside.

Lu Cheng drank a glass of water, then quickly threw away the disposable cup, changed his mask, and went to the adjacent debridement room to begin the seventh debridement case of the night shift.

……

At 5:23 a.m., Lu Cheng and Du Yali, the assistant assigned to him in the emergency room, finally "quieted down".

After personally escorting the patient to the emergency room entrance, Du Yali turned back. Not very tall, she wrapped her left arm around her arm, looking like a cute little potato.

Lu Cheng looked at it and said with a smile, "A little tired, aren't you?"

Du Yali nodded: "I'm so tired, Dr. Lu. Are you tired too?"

Lu Cheng sat down, poured himself another cup of hot water, and leaned against the wall: "With the sudden change in weather, there will definitely be more patients with external injuries."

"Actually, it's not too bad. There weren't any patients with major trauma. Otherwise, it would have been much more difficult to save them."

"Debridement is physically demanding, but not mentally taxing."

Du Yali also found a round steel stool and sat down against the wall of the debridement room, still shrugging her shoulders: "Your surgery is really physically demanding. I didn't feel like I did anything special, but my hands are so sore."

Lu Cheng said, "The patients who came today are not heavy. If it were a big fat man weighing over 200 pounds who had a fracture, we would need to lift one of his legs and support it until the surgery was over to disinfect him."

Du Yali was astonished: "A fat man weighing over 200 pounds, doesn't one of his legs weigh over 100 pounds?"

"No, a single lower limb usually accounts for one-fifth to one-sixth of a person's total weight, around forty or fifty pounds. Even a very obese person weighing over three hundred pounds would only weigh sixty or seventy pounds."

After Lu Cheng finished speaking, he suddenly remembered that the wound cleaning kit was gone, and quickly said, "Du Yali, go and tell the nurse on duty in your emergency room that we're out of wound cleaning kits!"

Du Yali rolled her eyes: "I already said, they've definitely gotten them all back by now."

"Dr. Lu, just hope that no patients will come."

Lu Cheng said, "Of course I want to rest too, but you don't know that when I'm on night shift, the peak hours are after midnight and around 6 or 7 in the morning."

"When you're at work or running a stall... there are more accidents..."

Du Yali picked up her phone and said, "Sister Juan took a lot from the warehouse, so it should be enough for today."

"Dr. Lu, you're so fast! You seem to have done nine already?"

"Yes, there are nine."

"Both my patients and I are just unlucky," Lu Cheng chuckled.

"I hope no more patients come..." Du Yali lost interest in playing on her phone and leaned against the wall to close her eyes and rest.

However, Lu Cheng also planned to rest for a while, but unexpectedly, before he could put his phone back, a loud rolling sound came from the direction of the emergency department lobby.

Shouts rang out: "Traumatic abdominal hematoma! Take him to the emergency room!"

"Administer oxygen, monitor cardiac activity, check vital signs, establish intravenous access!" the doctor in the emergency room shouted immediately.

“Call Lu Cheng in surgery.”

Lu Cheng had already stood up, put on a mask again, and ran quickly toward the emergency room.

When Lu Cheng saw the patient, the patient already had a fairly typical frog-like abdomen, which was a sign of a large amount of fluid accumulation in the abdomen.

The ambulance driver in green said, "When the patient first got on the ambulance, his abdomen wasn't this distended. This definitely indicates active bleeding."

"Quickly request a surgical consultation and get him into the operating room as soon as possible."

"Beep beep beep..." As I spoke, the blood pressure monitor emitted a series of beeping alarm sounds.

"70 bpm!" the nurse said.

The lower the blood pressure, the shorter the working time of the blood pressure monitor, and the faster the blood pressure data is obtained.

Lu Cheng had already arrived at the bedside. After checking the patient's eyelids and finding no change in pupil size, he immediately said, "Quickly fix him here. We need to perform an emergency abdominal surgery to stop the bleeding."

"Initiate intravenous access and immediately begin fluid resuscitation!"

"Du Yali, call the general duty officer for me. I need to perform an exploratory laparotomy here." Lu Cheng directly assigned this task to a specific person.

"Okay, I'll call right away." Du Yali walked to the side.

"Heart rate 144! Blood oxygen 91%!" Another alarming report came from the nurse's end. "Has the IV line been established? Administer norepinephrine via intravenous bolus!" The voice of Associate Chief Physician Long Chunbo from the Internal Medicine Department was stern.

"Still looking for a vein!" a nurse replied quickly.

"No airway obstruction was found at the scene!" The ambulance doctor said as he signed the handover document while seeing that Long Chunbo was still observing his airway.

"That still requires intubation!"

"Call for an emergency ultrasound, an urgent consultation with general surgery. Call hematology." Long Chunbo continued to issue various medical orders rapidly.

"Pre-transfusion tests, blood typing, liver and kidney function tests..."

Lu Cheng, on the other hand, calmly pulled the patient's shirt up to its maximum extent.

Fortunately, the patient was male, so there weren't many privacy concerns, which saved Lu Cheng at least ten seconds of rescue time.

Lu Cheng took the iodine complex and poured it directly onto the patient's navel, then continuously drew circles outwards, the dark iodine complex rolling around on the patient's abdomen.

"Give me the knife." Lu Cheng turned his head.

"The wound cleaning kit hasn't been opened yet," a nurse said.

Lu Cheng could only remove the wound cleaning kit himself, violently tear it open, and then casually wipe the patient's abdominal wall with the gauze inside before starting to insert the sterile scalpel.

They'll be using a negative pressure suction device for sputum suction, so Lu Cheng said, "We'll put in a negative pressure suction tube later!"

"Note the time: 5:28 AM. The patient suffered massive internal bleeding and went into shock. We performed laparotomy to stop the bleeding and provide emergency treatment." As Lu Cheng spoke, his hands didn't stop; he directly cut open the patient's abdominal wall.

This swift and decisive action made Long Chunbo frown deeply.

Today wasn't his first day working with Lu Cheng, but Lu Cheng had always been very proper before today. Even when he encountered patients like this, he would wait for a surgical specialist to come for a consultation before sending the patient to the operating room.

We wouldn't dare to perform open surgery on the abdomen right there in the emergency room.

However, Long Chunbo had obviously heard about Lu Cheng's situation. The hospital had taken the initiative to contact Lu Cheng and granted him the authority to enter the operating room and emergency room to perform laparotomy and hemostasis.

“Dr. Lu, we’ve already reported and authorized the chief on-call supervisor. That’s what they said.” Du Yali approached.

"Put on gloves, make a pinky promise!" Lu Cheng interrupted, not letting Du Yali waste any more time!
I've already asked for authorization, and the duty officer won't refuse; they'll definitely give other instructions, but those aren't important.

The family members are not here, the police haven't come, so the document cannot be signed.

As for signed documents, critical illness notices, and other documents, they can only be submitted later.

If the patient cannot be saved, the family members will need to claim the death certificate and the record of the resuscitation process.

Lu Cheng exposed the patient's abdomen quickly, opening it up in no time. However, since they were not in the operating room, there was no abdominal retractor, so Lu Cheng had to use his own abdomen to press down on one end of the retractor for leverage.

With no one on the other side to make a hook, Lu Cheng could only operate with half of his vision.

There was a lot of residual blood in the abdomen, but the rate of blood loss was not that rapid; otherwise, given the long transfer period, the patient would have lost the chance to be saved long ago.

After glancing around a few times and roughly determining that the bleeding was in the upper abdomen, Lu Cheng patiently began to search for the source of the bleeding.
But soon, Lu Cheng's expression changed drastically: "The pancreas has ruptured, and there is a hematoma in the retroperitoneum."

"Quickly establish dual intravenous access," Lu Cheng shouted.

"Do we need to get another one?" Nurse Chen Juan asked, her tone slightly displeased.

Lu Cheng's order was very clear: "Another system must be established."

After that, Lu Cheng only briefly reviewed the anatomy of the abdominal blood vessels before immediately ligating the splenic artery.

The largest branch of the pancreas's blood supply is the splenic artery.

Of course, after addressing the main pathways, further exploration of the branches of the gastroduodenal artery and pancreaticoduodenal artery is needed...

Lu Cheng quickly and skillfully cut along the splenic-colonic ligament and directly entered the lesser omental bursa.

At the same time, it moved towards the upper edge of the pancreatic tail, where the splenic artery is often located!

Although Lu Cheng doesn't come often, he has visited quite a few times, almost like coming home.

Moreover, at this moment, Lu Cheng also confirmed by touch that it was indeed bleeding from a ruptured pancreatic tissue.

Lu Cheng quickly lifted the retroperitoneum with toothless forceps, bluntly separated the loose tissue above the pancreatic tail, and then clamped the main trunk of the splenic artery with a vascular clamp.

Of course, Lu Cheng quickly realized that the bleeding was in the uncinate process. The uncinate process of the pancreas is a hook-shaped protrusion extending to the left from the head of the pancreas. The major blood supply to this location comes from the gastroduodenal artery and the superior mesenteric artery.

This patient's preperitoneal hematoma also involves the superior mesenteric artery!
After clamping the splenic artery, Lu Cheng immediately pushed the intestines back, and then, with Du Yali's help, he pushed the transverse colon upwards with hooks, while moving the jejunum and ileum to the lower left abdomen.

This exposes the neck of the pancreas, and the superior mesenteric artery is located below the junction of the horizontal part of the duodenum.

After cutting open the retroperitoneum, Lu Cheng inserted the hemostat again. He wasn't clamping the superior mesenteric artery, but rather the inferior pancreaticoduodenal artery.

Of course, even after doing all this, it's still not over.

Lu Cheng still needs to examine the gastroduodenal artery!

After quickly locating the hepatoduodenal ligament, the anterior lining was cut open to expose the common bile duct, proper hepatic artery, and other tissues. Then, the pulsation of the proper hepatic artery was located on the left side of the common bile duct.

The origin of the gastroduodenal artery needs to be traced from the proper hepatic artery to the common hepatic artery, then the right gastric artery, the gastroduodenal artery, the right gastric omental artery, and the superior pancreaticoduodenal artery.

After accurately locating it and trapping it, Lu Cheng finally breathed a sigh of relief.

Then they began clearing the hematoma in the anterior abdomen and searching for other bleeding points in the superior mesenteric artery...

As Lu Cheng's movements slowed down and became more precise, the rescue scene became less bloody.

No one could appreciate Lu Cheng's actions, not even the patients.

But patients can silently prove that all of this is meaningful by prolonging their lives.

"Lu Cheng, how are things on your end?" Long Chunbo asked.

"Director Long, all the larger bleeding points have been dealt with. Transfer the patient to the CT room, and then to the operating room. Ask the blood bank to send some blood," Lu Cheng reported.

"The patient's blood pressure is still low, but it's slightly better than before. But it's only slightly better," the nurse said.

"Send him to the CT room, then transfer him to the operating room," Lu Cheng instructed.

The remaining procedures absolutely cannot be completed in the emergency room.

Hearing Lu Cheng's enthusiasm, Long Chunbo asked with a slightly hesitant tone, "Will it make any sense?"

In Long Chunbo's view, even if such patients were to enter the operating room, they would most likely die, because he worked with many doctors.

Long Chunbo only knows the approximate statistics of his own experience.

"It's possible, Director Long!" Lu Cheng replied.

"Send it to the CT room," Long Chunbo said.

Lu Cheng was a seasoned attending physician, and he had his own principles. Long Chunbo couldn't possibly order him to stop the resuscitation. He just thought that perhaps Lu Cheng would gain experience from his many failures.

(End of this chapter)