This miracle doctor just wants to be fired!

Zhou Cheng had no idea what Fang Hang was thinking, and even if he did, he would only sigh a couple of times.

He is focused on himself and cannot please everyone.

Just like Wang Jianming, the former director of the emergency department, no matter what he did, he could never win the other party's favor.

……

At 3 p.m., it is the busiest time of day in the emergency department.

The waiting hall was packed with people, with crying children, groaning elderly people, and anxious family members crammed together.

The door to the emergency room opened and closed repeatedly, and stretchers were brought in one after another.

The medical staff moved with such speed that they didn't even have time to drink water.

Zhou Chenggang had just finished treating a patient with acute gastroenteritis and dehydration. He was writing medical records with Zhao Xiao and Wang Zihao in the doctor's office and was also explaining the key points of differential diagnosis for acute abdominal pain to the two resident trainees.

Just as I finished explaining the key points for distinguishing between appendicitis and mesenteric lymphadenitis, a sharp ambulance siren suddenly sounded outside.

Immediately afterward, a young nurse from the department rushed in, panicked: "Doctor on duty, come to the emergency room immediately! An ambulance brought in a 18-month-old child who choked on a foreign object. He's having difficulty breathing and can barely catch his breath!"

The entire emergency room doctor's office fell silent immediately.

Doctors who weren't busy with anything all stood up and ran out the door at the same time.

Zhou Cheng immediately closed the medical record book, grabbed the stethoscope, and rushed into the emergency room.

Zhao Xiao and Wang Zihao jogged after them.

……

The first bed in the emergency room was already surrounded by people.

A small boy lay on the gurney, his face pale, his lips and fingernails bluish-purple, his chest heaving violently, but he could only make weak gasps, and his hands and feet twitched slightly from time to time.

The child's grandmother collapsed at the entrance of the emergency room, crying uncontrollably.

The child's parents clung to the door frame, their faces as white as paper, their eyes fixed on the child on the bed, forgetting even to cry.

"What's going on?" Zhou Cheng quickly stepped forward and took the handover form handed to him by the 120 doctor.

"The child is 1 year and 7 months old. Twenty minutes ago, when his grandmother was feeding him pine nuts, the child cried and accidentally choked on the pine nuts and they went into his trachea. He then coughed violently and had difficulty breathing."

The 120 doctor quickly explained the patient's condition.

"When we arrived at the scene, the child's lips were already turning blue. We immediately performed a head-down, hip-high back patting and Heimlich maneuver, repeating it more than ten times, but it had no effect at all; the foreign object was not expelled."

"On the way, we provided them with a mask and high-flow oxygen, and contacted the ENT, pediatrics, anesthesiology and ICU departments for an emergency consultation, asking them to come over immediately."

Zhou Cheng nodded and immediately stepped forward to examine the child.

The child's consciousness was somewhat blurred, and he only responded weakly to being called. Both pupils were large and round, and the light reflex was still sensitive.

He placed the stethoscope against the child's chest and listened carefully to the breathing sounds in both lungs.

The breath sounds in the left lung are coarse, with scattered dry and wet rales. The breath sounds in the upper right lung are significantly reduced, and the breath sounds in the lower right lung are completely absent, with no airflow sounds audible at all.

"Heart rate 172 beats/min, respiratory rate 36 breaths/min, blood oxygen saturation 66%!"

After connecting the cardiac monitor, the nurse loudly announced the readings from the monitor. The piercing alarm for low blood oxygen saturation kept ringing in the emergency room, gripping everyone's hearts.

At this moment, the ENT specialist arrived first; it was the attending physician, Liu Kai.

Holding a laryngoscope and forceps, he rushed to the bedside and immediately ordered, "Come on, two people hold the child, head down, hips up, I'll try patting his back and thrusting again, see if I can shake the foreign object out!"

Two nurses immediately stepped forward and carefully turned the baby over, head down and buttocks raised.

Liu Kai used his cupped hands to pat the child's back quickly and forcefully between the shoulder blades, patting it more than a dozen times. Then, using the Heimlich maneuver, he wrapped his hands around the child's upper abdomen and thrust upwards several times.

But the child didn't react at all!

Instead of coughing up anything, the child suddenly vomited, and a mouthful of milk gushed out of his mouth and nose.

The child's breathing became even weaker, the cyanosis of his lips deepened, and his eyes slowly closed.

My consciousness completely blurred!

"No, patting his back isn't working! The child's oxygen deprivation is getting worse!" The pediatric consultant arrived and, seeing the situation, immediately shouted, "Where's the anesthesiologist? Intubate him immediately! Open his airway and ensure oxygen supply, otherwise the child's heart will stop beating soon!"

Just then, the anesthesiologist rushed in pushing an intubation cart. Without saying a word, he quickly administered a short-acting sedative to the child and took out a pediatric endotracheal tube.

The whole process was swift and efficient, and it was successful on the first try.

After auscultation confirmed that the intubation tube was in the correct position, the ventilator was immediately connected, and CPAP mode was set to PEEP 6 cmH2O for assisted ventilation.

The moment the ventilator was connected, the blood oxygen saturation on the monitor slowly started to rise.

The heart rate rose from 60% to 75%, then to 82%, and the child's heart rate gradually dropped to 140 beats per minute.

The rise and fall of my chest also became a little more stable.

Everyone breathed a sigh of relief. Liu Kai wiped the sweat from his forehead and looked at Zhou Cheng, saying, "First, stabilize the blood oxygen. I've already contacted the operating room and they're preparing a rigid bronchoscope. We'll go in and remove the foreign object; that's the only way."

The pediatrician nodded: "Yes, the main airway is now open after intubation, and the blood oxygenation can be stabilized. Contact the operating room immediately, the sooner the better. If the foreign object is stuck in the right main bronchus for too long, the right lung will be completely necrotic, and it will also cause suffocation."

In emergencies like this, surgery is the only solution!

But no sooner had he finished speaking than the monitor's alarm blared out sharply again.

The child, who had been calming down, suddenly became extremely agitated, kicking his arms and legs, shaking his head violently, and completely resisting the ventilator.

The blood oxygen saturation on the screen plummeted from 82% to 40%, and the heart rate spiked to 180 beats per minute. The child's face instantly turned bluish-purple.

"Oh no, the oxygen deprivation has worsened during the human-machine combat!"

The anesthesiologist immediately adjusted the ventilator parameters, increasing the tidal volume, but it had no effect.

My blood oxygen level is still stuck at 40% and won't go up.

"Give them 3mg of diazepam to sedate!"

The pediatrician immediately gave the prescription, and the nurse quickly administered the medication.

The child's irritability gradually subsided, but the blood oxygen level remained at only 45%, and it simply couldn't rise.

Liu Kai's face instantly darkened: "Damn it, the foreign object has completely blocked the right main bronchus, and there are also pine nut fragments blocking the left main bronchus. Tracheal intubation can only ensure ventilation of the main airway, but air cannot enter the lungs. No matter how much oxygen the ventilator gives, it will be useless."

Her blood oxygen levels are unstable right now; she won't make it to the operating room. Her heart might stop beating on the way!

The moment those words were spoken, the emergency room fell silent, save for the piercing alarm of the monitor.

Everyone knows that the current situation is a dead end.

Conventional back patting and Heimlich maneuvers were ineffective, and endotracheal intubation and mechanical ventilation could not maintain blood oxygen levels.

Rigid bronchoscopy to remove the foreign object is the only way to cure the problem, but the child can't even endure the ten-odd minutes it takes to get to the operating room.

……

The child's mother heard what was being said inside the emergency room, her legs went weak, and she collapsed to the ground, crying and screaming.

"Doctor, please, please save my child! He's only a little over a year old!"

The child's father's eyes also reddened, and he bowed repeatedly to the doctor inside, his waist almost touching the ground.

Just when everyone was at a loss, Zhou Cheng, who had been standing by and watching the monitor, suddenly spoke up: "I have a way."

All eyes immediately turned to him.

Liu Kai frowned: "The child's heart could stop at any moment. A rigid bronchoscopy is the only option; there is no other way."

"We can't use a rigid bronchoscope right now; the child's blood oxygen levels aren't high enough, and we can't wait."

Zhou Cheng spoke calmly, pointing to the monitor and then to the child's chest X-ray.

"The foreign object is stuck in the right main bronchus, and there are also fragments blocking the bronchus in the left lung. The endotracheal tube can only reach the main airway and cannot reach the foreign object in the bronchus, so the ventilator cannot get air in, and no matter how the parameters are adjusted, it is useless. The only way now is to cough up the foreign object."

The anesthesiologist immediately shook his head: "Impossible. The child is currently under sedation and cannot cough at all. Moreover, with an endotracheal tube inserted, the cough reflex is suppressed. Even if the child could cough, the foreign object would only get stuck in the tube, which would be even more dangerous."

"So we need to remove the tube." Zhou Cheng stated his plan directly, without any unnecessary words. "Slowly remove the endotracheal tube, use the end of the tube to stimulate the carina to induce the child's cough reflex, and at the peak of the child's cough, pull the tube out completely. At the same time, use the Heimlich maneuver to thrust into the upper abdomen, using the high pressure in the chest cavity generated by the cough to flush out any foreign objects in the bronchi with the airflow."

These words immediately caused an uproar in the emergency room.

"Are you crazy? Pulling out the tube? The child's blood oxygen level is only 40% with the tube in. If you pull out the tube, the main airway will be blocked, and the child will suffocate instantly, and their heart will stop beating immediately!"

Liu Kai raised his voice.

"That's right, Zhou Cheng, the risk is too great. If the foreign object doesn't come out, the child won't even have a chance for a second intubation. Who will take responsibility?" The pediatrician also chimed in with his advice.

At some point, Li Degang arrived. He tugged at Zhou Cheng's arm and said in a low voice, "Xiao Zhou, think carefully. This isn't just any child; it's a toddler. If anything goes wrong, the consequences will be unimaginable. Think of other options. If all else fails, call the ICU to start extracorporeal circulation at the bedside to save his life."

"Extracorporeal circulation won't be fast enough; preparation alone takes more than half an hour, and the child can't handle it."

Zhou Cheng shook his head, his gaze sweeping over everyone.

"We've tried all the conventional methods, but they're useless. If we wait another ten minutes, the child's blood oxygen level won't rise. If the brain is deprived of oxygen for too long, even if we manage to save him, he'll become a vegetable, or even suffer cardiac arrest."

"This method is risky, but it's the only chance we can save him right now."

He paused, then continued, "I've seen similar cases in the literature before, where children had foreign bodies in their trachea, and conventional methods were ineffective, but this method successfully removed the foreign body. I'm confident that the procedure won't take more than ten seconds, and even if it fails, we can immediately reintubate without delaying the rescue."

Everyone fell silent, staring at the monitor showing only 40% blood oxygen and the child's increasingly weak breathing. No one spoke.

They all knew that Zhou Cheng was telling the truth; there was no other way to go now.

"I'll go talk to the family." Zhou Cheng turned and walked out of the emergency room. He went to the child's parents and explained the situation directly, "The child has a pine nut stuck in his trachea. Conventional methods are not working. The ventilator can't maintain blood oxygenation. He won't make it to the operating room to remove the foreign object."

"There is an emergency solution now. It's risky, but it's the only chance to save the child. If it succeeds, the foreign object can be expelled, and the child can live."

"If it fails, the child may suffocate and their heart may stop beating. If you agree, I will proceed now."

The child's father looked at the constantly beeping monitor in the emergency room, then at his wife who was crying uncontrollably in his arms, gritted his teeth, and his eyes reddened.

"Doctor, we believe in you! Please save him! Whatever the outcome, we'll accept it!"

After saying that, he signed the informed consent form with trembling hands.

Zhou Cheng, holding the signed consent form, strode back to the emergency room and immediately ordered, "Get ready! Wang Zihao, you're in charge of securing the child's head and shoulders. Zhao Xiao, prepare the negative pressure suction device; suction the nasal and oral secretions as soon as the foreign object comes out. Prepare a new endotracheal tube and laryngoscope; if the procedure fails, reintubate immediately. Defibrillator, adrenaline, and the resuscitation cart—all ready by the bedside!"

Everyone immediately sprang into action, each fulfilling their assigned duties.

The emergency room fell silent instantly, with only the beeping of the monitors remaining.

Zhou Cheng put on sterile gloves, stood beside the child's head, held the endotracheal tube with one hand and placed the other on the ventilator connector, took a deep breath, and said, "Everyone, pay attention, I'm about to extubate. Keep a close eye on the monitors!"

He first unplugged the ventilator, then slowly and steadily pulled out the endotracheal tube, his eyes fixed on the heart rate and blood oxygen levels on the monitor.

When the end of the endotracheal tube was moved to the position of the carina, he deliberately rubbed the mucous membrane of the carina with the end of the endotracheal tube.

The carina is the most sensitive part of the human airway; even slight stimulation can trigger a violent cough.

Even though the child was given a sedative, he instantly developed a strong cough reflex, his small body arched sharply, his chest heaved violently, and he let out a muffled cough.

It's now!

At the moment when the child's cough reached its peak, Zhou Cheng quickly exerted force with his wrist and pulled the endotracheal tube out completely.

At the same time, the other hand quickly wraps around the child's upper abdomen, the two hands are stacked together, and with a force suitable for young children, it thrusts upwards three times quickly and accurately.

In that instant, a large amount of white secretions gushed out of the child's mouth and nose, along with half a bloody pine nut and several pieces of pine nut crumbs!

"Suck! Quickly suck out the secretions!"

Zhou Cheng shouted, and Zhao Xiao immediately took the negative pressure suction tube and quickly sucked the secretions from the child's mouth and nose. At the same time, she put the mask over the child's mouth and nose and administered high-flow oxygen.

Everyone's eyes were glued to the monitor, where the blood oxygen saturation level was rising at a visible rate.

It rose from 40% to 60%, 80%, 90%, and finally settled steadily at 95%!

The child's cyanosis faded instantly, restoring its rosy color.

Her heart rate gradually dropped to 120 beats per minute, her breathing became steady, and she even slowly opened her eyes and let out a faint cry.