Tokyo, 1994, starting with medical training

Chapter 31 Do you even have the right to speak?

"Establish two intravenous access lines and insert indwelling needles, the largest size, 14G!"

"Full-speed rehydration, lactated Ringer's solution, two bags on an IV drip!"

"Oxygen inhalation, face mask, flow rate 10 liters!"

"Draw blood to check blood type, crossmatch, complete blood count, and coagulation function. Notify the blood bank to prepare blood: at least 10 units of red blood cell suspension and 1000 ml of plasma!"

"ECG monitoring connected!"

"Also, notify the on-call doctors in the First and Second Surgical Departments!"

As Kiryu Kazusuke detected the faint pulse beneath his fingertips, he issued a series of commands.

After all, he couldn't be considered an ordinary medical trainee. His experience in the emergency department in his previous life allowed him to remain absolutely calm in such a chaotic situation.

Motivated by his imposing presence, the nurses quickly and efficiently began their procedures.

Kiryu Kazusuke skillfully picked up the laryngoscope, lifted the epiglottis, and precisely inserted the endotracheal tube into the glottis: "Intubation successful, connect the breathing bag."

The flatcar had just come to a stop.

Next, a physical examination was conducted.

Without even needing a stethoscope, just by looking at his abnormal breathing movements, one could tell that he had multiple rib fractures on the left side, a flail chest.

He reached out and pressed on his pelvis.

click-

A clear grating sensation came from my hand; the pelvic ring felt loose, like a broken basket.

Extremely dangerous!

Pelvic fractures are often accompanied by tearing of the pelvic venous plexus, and the amount of bleeding can reach several thousand milliliters in an instant, which is one of the main causes of shock and death.

Then touch the abdomen.

It is as hard as a wooden board, with a board-like abdomen.

This means that there is definitely a ruptured organ inside the abdominal cavity, and there is massive bleeding!

"Don't insert the catheter yet, we suspect a urethral rupture." Kiryu Kazusuke stopped the nurse who was about to insert the catheter and turned to shout, "Hey you, go get the ultrasound machine! Quickly!"

At this point, there was no time to take an X-ray; an abdominal Echo (ultrasound screening) had to be done immediately.

He applied coupling gel to the probe and pressed it onto the patient's abdomen.

On the screen, although the resolution is not high, a distinct fluid-filled dark area can be seen in the spleen and kidney recesses.

It was all blood.

Kazusuke Kiryu's expression was grave: "The shock index is over 2.0, and the blood loss is at least 2000 ml."

Just then, the emergency room door was pushed open again.

A man wearing a white coat and with messy hair walked in, looking like he hadn't woken up yet.

Minamimura Shoji, the on-call resident surgeon for the First Surgery Department tonight, is less senior than Takikawa Takuhei, and usually likes to act like a senior.

He had just fallen asleep in the duty room when he was woken up by a phone call. He was already angry, and when he heard it was about a fall from a height, he reluctantly came over.

"What are you doing! Who gave you permission to touch the patient?"

Minamimura Masaji wanted to scold him as soon as he entered the door.

He wanted to find fault, such as the resident doctor's slow response or misjudgment, in order to demonstrate the authority of the senior doctor.

But when he glanced at the monitor and the IV drip already flowing at full speed, he swallowed back the swear words that were about to come out of his mouth.

Endotracheal intubation has been completed, and breath sounds are symmetrical.

Dual-channel infusion is being administered at full speed.

The blood transfusion request has also been issued.

Even the pelvic girdle has been fixed, effectively limiting the pelvic volume and temporarily stopping the bleeding.

Following this entire process is like opening a first aid guide and following it exactly as you would.

It was even faster than he could learn it himself.

"Comminuted fracture of the pelvis, combined with ruptured abdominal organs, flail chest," Kiryu Kazusuke reported without turning his head, holding a laryngoscope. "His blood pressure is still dropping; he needs surgery immediately."

"Do you even need to tell me?" Minamimura Shoji stepped forward, pressed the patient's stomach, looked at the X-ray, and snorted coldly.

He glanced at his blood pressure, which was still dropping: 50/30, and his heart rate: 150.

"Notify the operating room to prepare for operation!"

"Call the people from the Second Surgery Department here too!"

Unable to find a reason to reprimand Kiryu Kazusuke, he issued the order with a stern face.

But he wasn't trying to shirk responsibility.

In the 90s, Japanese university hospitals implemented a strict "lecture system," and departments were named not according to body parts, but according to the order of their establishment.

Because of its long history, plastic surgery (orthopedics) occupies the throne of "first surgery," while general surgery, which is responsible for the core organs such as the gastrointestinal tract, liver, gallbladder, and pancreas, can only be relegated to "second surgery."

The two departments have a long-standing grudge over competition for operating room resources, beds, and funding.

The two families often argue fiercely about who should treat the multiple injuries.

Not long after.

The on-call doctor from the Second Surgical Department also arrived.

The man who came was Dr. Inoue Kazuki from the Second Surgery Department. He was not tall, but he had a very short temper.

He held the vial of non-clotting blood that had just been drawn, his face grim: "Positive abdominal paracentesis, it's all blood!"

"It's definitely a ruptured spleen or liver; we must immediately perform abdominal surgery to stop the bleeding!"

Minamimura Shoji immediately objected: "No way!"

"The X-ray shows an unstable pelvic fracture, and there is definitely a huge hematoma in the retroperitoneum."

"The retroperitoneum is intact now, and the pressure can still barely stop the bleeding."

"If you open the abdomen now, the abdominal pressure will drop, and the retroperitoneal hematoma will rupture instantly, gushing blood out like a floodgate opening!"

"How will you stop the bleeding then? Will you try to stop it with your hand?"

"An external fixator must be used first to stabilize the pelvis!"

Dr. Inoue threw the syringe he was holding into the dish: "Bullshit!"

"Massive abdominal bleeding is the fatal injury. His blood pressure has dropped to 50. If we don't go in to stop the bleeding soon, he'll shock and die!"

"Don't you understand, First Surgery Department?!"

In the corridor in front of the operating room, doctors from two departments were arguing heatedly.

Neither side was willing to give in.

Which to treat first is the classic dilemma of death in trauma surgery.

Bleeding from a pelvic fracture is mainly caused by the venous plexus, which relies on the "packing effect". Once the abdomen is opened to relieve pressure, the blood clots that have just solidified will break open, leading to uncontrollable massive bleeding, which is fatal.

However, internal bleeding is arterial, and it is also necessary to ligate and stop the bleeding, otherwise, the bleeding will eventually stop and death will be inevitable.

It's like defusing a bomb.

Cutting the red wire will cause an explosion, and cutting the blue wire will also cause an explosion.

But patients can't wait.

The heart rate readings on the monitor are soaring, while the blood pressure continues to drop.

"So you're just going to watch him die?"

"If he dies from hemorrhagic shock after abdominal surgery, then your Second Foreign Language Department is just messing around!"

"Huh? What did you say, you bastard?"

Seeing that the two senior doctors were about to fight at the entrance of the operating room, the nurses and anesthesiologists around them looked at each other, none of them daring to intervene.

Kiryu Kazusuke stood to the side, watching the increasingly flattened curve on the electrocardiogram monitor.

My heart rate has soared to 160, and my blood pressure is undetectable.

If this argument continues, this person might as well be taken to the morgue.

Although he was just an insignificant medical trainee, he had no say here and could do nothing so as not to make mistakes.

But he couldn't bear watching his patients slide into the abyss of death.

"Use C-clamps!"

Kiryu Kazusuke suddenly reached out and stood between the two, calmly speaking.

"What?" Minamimura Shoji turned around and glared at him fiercely. "Do you even have the right to speak here? Shut up!"

It is a serious taboo for a resident physician to interrupt a debate between senior doctors.

But Dr. Inoue paused for a moment, then asked, "What did you mean by forceps?"

"Emergency fixation with C-clamps for the pelvis." Kiryu Kazusuke explained quickly, ignoring Minamimura Shoji's reprimand.

"The current dilemma is that opening the abdomen will reduce pressure and cause massive pelvic bleeding, while not opening the abdomen will result in uncontrollable internal bleeding."

"Then let's address the stress issue first."

"Using C-forceps for percutaneous puncture, we directly clamped the posterior part of the iliac bones on both sides, applied pressure from the outside, and forcibly closed the pelvic ring."

"This can quickly reduce the pelvic volume and use mechanical pressure to compress the retroperitoneal venous plexus to stop bleeding, replacing the role of intra-abdominal pressure."

"The operation only takes five minutes."

"After securing the pelvic bone, the second surgeon immediately performed an exploratory laparotomy. At this point, the reduced abdominal pressure will prevent massive pelvic bleeding."

"This is currently the only solution."

(End of this chapter)