After being separated from my family, I became a darling of the military region thanks to my medical

3:40 a.m.

Benjamin, six hours after surgery.

The internal phone in the intensive care unit rang.

Ye Zhen sat up on the folding bed in the lounge and grabbed the receiver.

Whitman's voice was strained.

"Dr. Ye, Benjamin has had a low cardiac output attack."

"Arterial pressure 68.42, mean pressure 49, heart rate 68. Extremities are cold, urine output has dropped to 0.4 ml/kg per hour."

Ye Zhen hung up the phone and opened the door.

Gu Zheng picked up his coat and followed behind her.

"I'll go and stand guard at the door."

"Don't let the reporters in."

"it is good."

Inside the intensive care unit, alarms continued to sound.

Five or six people were gathered around the insulated box.

Whitman held a syringe in her hand; the medicine had already been drawn up.

"Prepare to increase the dosage of dobutamine. The child's contractions are getting too much; first, raise the heart rate and blood pressure."

"Don't push."

Ye Zhen pressed down on his wrist.

Whitman stopped.

"If this drags on any longer, the cycle will collapse."

Ye Zhen did not take the syringe; instead, she went to the monitor first.

Heart rate 68.

Blood oxygen level: 79.

Arterial pressure 68.42.

She bent down to examine Benjamin's hands and feet, and then pressed his groin artery.

Peripheral irrigation is very poor.

The nurses are counting off.

"In the past twenty minutes, the traffic has not increased."

"Check three things first."

Ye Zhen raised her hand.

"Cardiocardiac tamponade, shunt occlusion, active hemorrhage."

The bedside ultrasound machine was moved next to the incubator.

The technician placed the probe against the chest wall.

The location of the pericardial cavity and the artificial blood vessel shunt quickly appeared on the screen.

Ye Zhen stared at the screen.

"No new fluid accumulation in the pericardium."

She pointed to the artificial blood vessel.

"There is continuous blood flow in the shunt, the flow rate is decreasing, but there is no blockage."

"There was no obvious bleeding around the anastomosis."

Whitman looked down at the scoreboard.

"It's not bleeding, it's not a blood clot, and it's not cardiac tamponade."

"Then we should increase the dosage of cardiac stimulants even more."

Ye Zhen pressed down on the recorder.

"The electrocardiogram shows sinus bradycardia, increased peripheral resistance, and decreased urine output."

"This is low cardiac output syndrome, not simply insufficient systolic strength."

Whitman paused for a moment.

"Your blood pressure has already dropped to this level, do you still need to consider vasodilators?"

Ye Zhen raised her head.

"Benjamin's shunt anastomosis is only 2.9 millimeters."

"When a large dose of cardiac stimulant is administered, myocardial contraction will increase, and ventricular pressure and shunt inlet pressure will both rise."

"The anastomosis was performed just six hours ago and it can't withstand the pressure fluctuations."

"Bleeding, lacerations, uncontrolled pulmonary blood loss—any one of these could keep him in the intensive care unit."

Stephen and Cohen arrived at the door just in time to hear these words.

Ye Zhen turned to the nurse.

"Start both pumps."

"First, dobutamine, starting at two micrograms per kilogram per minute."

"Second, sodium nitroprusside, 0.5 micrograms per kilogram per minute, pumped in synchronously."

Whitman raised her voice.

"Sodium nitroprusside lowers blood pressure!"

"So it's not used alone."

Ye Zhen retrieved the invasive arterial pressure waveform.

"A small amount of cardiotonic drugs maintains blood pumping, and a small amount of vasodilators reduces afterload."

"What we need to ensure is effective perfusion, not just piling up a number."

She pointed to the monitoring screen.

"If the mean arterial pressure is below 45, discontinue sodium nitroprusside."

"The shunt flow rate continues to decrease. First check the shunt and its capacity, then adjust the cardiac stimulant."

"If blood oxygen is above 90, check for excessive blood flow to the lungs immediately."

"Report blood pressure, heart rate, blood oxygen, and peripheral circulation every two minutes."

Whitman did not argue further.

He picked up the record board.

"Two micrograms of dobutamine."

"0.5 micrograms of sodium nitroprusside".

"If the mean blood pressure is below 45, discontinue vasodilators."

Ye Zhen looked at Stephen.

"implement."

Stephen picked up the walkie-talkie.

"Follow Dr. Ye's instructions."

Two pumps were connected to the intravenous access.

The medicine slowly entered Benjamin's body.

The numbers on the monitor began to change.

Sixty-eight.

seventy.

Seventy-two.

Whitman kept his eyes glued to the arterial pressure waveform, his hand never leaving the recording tablet.

"Heart rate 72."

"It's still cool at the extremities."

Ye Zhen did not adjust the pump speed.

"Continue reporting."

Two minutes later.

"Arterial pressure 76-46".

Heart rate 86.

"Blood oxygen at 80".

Two more minutes passed.

"Arterial pressure 849."

Heart rate 97.

The alarm is still going off.

Benjamin's chest rose and fell very slightly.

Ye Zhen stood beside the incubator, not moving an inch.

"Maintain the current pump speed."

"Don't rush to check your blood pressure."

Eighth minute.

"Arterial pressure 82.50".

"Average pressure is 59."

"Heart rate 108".

"Blood oxygen 82."

After the nurse finished reporting, the alarm stopped.

Whitman put down the spare medicine in her hand.

His forehead was covered in sweat.

The large dose of cardiac stimulant I just received didn't go down.

Otherwise, the shunt anastomosis that Benjamin just completed might not be able to hold up.

The concentration and rate of the two pumps covering the nucleus of Yezhen.

"Recheck blood gas in ten minutes."

Record urine output every fifteen minutes.

"A follow-up bedside ultrasound will be performed in half an hour."

"If any indicator worsens, find the cause first; do not add medication immediately."

Whitman quickly took notes.

"Two micrograms of dobutamine per kilogram per minute."

"0.5 micrograms of sodium nitroprusside per kilogram per minute."

"Blood gas analysis every ten minutes, urine output every fifteen minutes, and ultrasound re-examination in half an hour."

"Remember this clearly."

Old Cohen stood by the door, his notebook outstretched in his palm.

He wrote down every dose, every change in blood pressure, and the discontinuation threshold set by Ye Zhen.

Stephen turned his head to the side.

"Professor Cohen?"

Cohen did not stop writing.

"This titration method is not included in the standard emergency medical records."

He finished writing the last line.

"But every step she took was monitored and documented."

Before dawn.

Benjamin's lactate level dropped to 3.8.

Urine output gradually recovered.

Blood oxygen levels were maintained between 82 and 86.

The arterial pressure stabilized at 86.54.

The most dangerous part after the first surgery was temporarily suppressed.

Harrison walked into the ward carrying a brown paper bag.

"Dr. Ye, this is all the information about Emily's daughter."

"Ultrasound, electrocardiogram, two follow-up examinations, blood gas analysis, and consultation opinions from Boston Children's Hospital."

Outside the glass wall, Emily stood still, clutching the registration certificate in her hand.

She didn't leave all night.

Ye Zhen took the documents, pulled out the ultrasound film, and placed it under the viewing lamp.

The first one.

Perimembranous ventricular septal defect.

the second one.

The left ventricle is underdeveloped.

The third one.

Narrowing of the left ventricular outflow tract.

She flipped to the latest ultrasound measurement record and stopped.

The defect has a diameter of 9.3 millimeters.

The aortic valve margin is only one millimeter away.

The lower edge is close to the conduction bundle region.

The narrowest point of the left ventricular outflow tract is 4.8 mm.

The systolic pressure of the pulmonary artery is 63 mmHg.

Ye Zhen picked up the nighttime blood energy record again.

When a child is sleeping, their blood oxygen level can drop to as low as 74.

Harrison looked at her.

"Can we perform interventional closure?"

"able."

Ye Zhen put the documents back on the table.

"But it's not a regular blockade."

Whitman took two steps closer.

"Ventricular septal defect, smaller-than-expected left ventricular development; the original consultation opinion was to observe and follow up."

"They missed the left ventricular outflow tract stenosis and pulmonary artery pressure."

Ye Zhen pulled out a blank consultation form.

"The upper edge of the defect is too close to the aortic valve. After the conventional occluder is released, the fimbriae may compress the valve leaflets."

"If the lower edge is close to the conduction bundle and the position is off by half a millimeter, it may cause atrioventricular block."

"The left ventricular volume is also insufficient."

"After the blockage, all the pulmonary venous return is forced into the left ventricle, and her left ventricle may not be able to withstand it."

Whitman was silent for a moment.

"Then we can't do it?"

"It can be done."

Ye Zhen wrote a few lines on the paper.

"Re-perform 3D ultrasound and blood flow assessment before surgery."

"During the procedure, we first attempted balloon closure and monitored left ventricular pressure, aortic regurgitation, and conduction in real time."

"The surgical team is on standby, ready to switch to open-chest surgery at any time."

Harrison looked at the surgery application form.

"Risk level?"

She wrote two words in the risk rating column.

level four.

Whitman picked up a pen.

"Who will be the surgeon?"

Ye Zhen took the surgery application form.

"I."