Healing Doctor

Chapter 46 Corpus cavernosum puncture (Part 1)

Ji Xiang arrived at the Second Affiliated Hospital's emergency room as quickly as possible.

This time, the system task was not as calm as before; instead, it kept flashing, like an alarm light.

Perhaps this is the difference between emergency room duties. Without thinking too much, Ji Xiang threw his bicycle aside and ran into the hospital.

"Dr. Xiao Ji!" Colonel Wang waved and called out to Ji Xiang in a low voice.

"Teacher Wang!" Ji Xiang ran through the crowd. "What happened?"

The emergency department lobby was in chaos, except for the area in front of the emergency resuscitation room, which was relatively quiet.

Several people stood at the door with grim expressions, and people kept reporting the situation to them.

Of the people who reported the situation, Ji Xiang only recognized one—Dean Zhao.

Dean Zhao, who was once the center of attention, now seems like the most inconspicuous little star, impossible to approach.

"Two died on the spot, and the rest... from the explosion and fire, the number of burn patients has reached 16." Colonel Wang sighed, his short, stout body seeming to have shrunk a bit.

Such a serious accident would make anyone feel bad when they talk about it.

"Is it serious?" Ji Xiang asked a pointless question.

"Several patients with minor or moderate injuries were immediately transferred to the operating room. We currently have a severely burned patient whose intravenous access cannot be established… his condition is likely serious."

Ji Xiang checked the system task and realized that this was the patient who was "waiting to die" being referred to.

"I'll go take a look," Ji Xiang said.

"Don't go." Colonel Wang sighed. "It's more serious than we thought. Two people have already died, and we can't even insert a needle into the other one. The anesthesiology department and the nursing department have tried, but it's no use. He's about to die."

Ji Xiang was somewhat puzzled.

Seeing Ji Xiang's blank expression, Colonel Wang knew that this rookie had no idea what it meant, so he explained, "A major safety accident resulting in three deaths needs to be reported. The city has ordered that the patients must be brought back to life."

"At this point, it's better not to save them at all," Mr. Wu muttered dejectedly, his head bowed.

Colonel Wang shook his head. "Keep your voice down."

Mr. Wu sighed. Ji Xiang wondered what kind of things they had gone through to say such a thing.

But we can put off the gossip for now; the most important thing right now is to establish an intravenous access.

We can't just stand by and watch people die.

But Ji Xiang didn't even know the most basic details. He cautiously asked, "Teacher Wang, what's the patient's condition? Why can't we even insert the needle?"

"He was burned all over his body, even the soles of his feet were burned. There was only a small area on his right groin where you could see the blood vessels," Colonel Wang said. "But there was rotting skin and blisters. There was only that one blood vessel. In the end, it was Director Xu from the anesthesiology department who tried to place an intravenous line."

"and then?"

"It failed." Colonel Wang sighed again. "The blood vessels of severely burned patients are extremely precious. There was once a burn patient who was staying in the sterile room of the burn unit. When a doctor was changing the dressing, the intravenous access somehow came off. The doctor was scolded by the head of the burn unit for a week."

"..." Ji Xiang was speechless. As a rookie, he couldn't grasp just how serious the situation was, as Colonel Wang had described.

"Go up on stage and take a look later. You'll have to rotate through the burn unit sooner or later," Colonel Wang said. "Let's see what the milder patients are like first, so you won't be unable to handle it later."

There was a strong sense of mentorship involved, but Ji Xiang was in a hurry. He didn't say anything and turned to go to the bathroom.

"He has no manners at all," Mr. Wu said disdainfully, looking at Ji Xiang's tall figure.

"I came in such a hurry, and I was so nervous that my sphincter muscles... even a god couldn't stand holding in his pee." Colonel Wang was quite lenient with Ji Xiang.

Ji Xiang found a quiet place, held his breath, and entered the system space.

"Teacher, you know about the mission, right?" Ji Xiang asked anxiously as he came in.

Although the flow of time in the system space is different from that outside, Ji Xiang, this newbie, has unknowingly been assimilated by that tense and oppressive atmosphere and immersed in it.

"Understood." The system NPC bowed slightly with his hands behind his back and said slowly, "Go and check on the simulated human first, then tell me your opinion on how to handle it."

It turned out everything was already prepared. Ji Xiang didn't stand on ceremony with the system NPC and strode into the operating room.

A mannequin covered in burns lay on the operating table. Ji Xiang glanced at it and felt a chill run down his spine.

So this is what full-body burns look like.

The mannequin's body was covered in carbonized areas, with red patches and blisters in the less affected areas. There wasn't a single intact piece of skin left, no wonder they said you couldn't even prick it with a needle.

"Generally speaking, scalp vein needles and groin catheters are the most common ways to establish intravenous access for burn patients," the system NPC explained. "But this patient's injuries are severe; only the genital area is basically unaffected. However, there are many blisters in the groin area. Please take a look."

Ji Xiang gradually felt helpless.

The system task is correct; there is simply no way to establish an intravenous access. Apart from a small area the size of a palm on the lower body, there is no other intact area on the patient's body.

"Teacher, how do I do this?" Jixiang asked blankly.

"I'll teach you," the system NPC said calmly. "I showed you the anatomy of the corpus cavernosum on the first day. Tell me about it."

"The numerous cavernous sinuses behind the corpus cavernosum act like valves; stimulation causes local smooth muscle relaxation, allowing a large amount of blood to be pumped in..."

As Ji Xiang spoke, he immediately understood what the system NPC meant.

But... administering an IV via puncture of the corpus cavernosum? Ji Xiang had never even heard of such a method.

"Teacher, do you mean intravenous infusion is administered through the corpus cavernosum?" Ji Xiang asked tentatively, afraid that he had misunderstood.

"Hmm." The system NPC nodded.

Ji Xiang was both amused and exasperated.

The corpus cavernosum is not a blood vessel!

Logically speaking, it seems... possible.

However, judging from the helpless expressions on the faces of Colonel Wang and General Manager Wu outside, even veterans in the urology department probably haven't done anything like this.

"The basic principle is like this. I'll demonstrate it once and you can watch." The system NPC put on sterile gloves and began to operate.

The surgical area was simply prepared, and any remaining hair roots were cleaned again.

The system NPC then began disinfecting the skin around the penis.

Hold the corpus cavernosum with your index finger and thumb to fix its posterior position. Select the right side of the corpus cavernosum, in the area without subcutaneous veins on the side.

"Note that you should avoid damaging the dorsal neurovascular bundle and the ventral urethra here."

When the system NPC reached this step, it gave Ji Xiang some instructions.

Ji Xiang nodded. He understood the system NPC's operation. It wasn't difficult; it was just a matter of mindset.

He was curious whether it would actually work.

After all, Ji Xiang had never seen, heard of, or even thought about intravenous infusion via the corpus cavernosum.

The system NPC used a No. 6 infusion needle to insert it into the corpus cavernosum at a 45° angle from the side for about 2cm, and then advanced about 0.5cm after piercing the white membrane.

"There's a specific method for using IV needles, but I won't go into details now. You'll have to experience it for yourself later," the system NPC explained. "A 45° angle from the side is the best. Given the patient's condition, insert the needle about 2cm. When the needle pierces the white membrane, you'll feel a sense of emptiness."

"Pierce the white membrane by 0.5cm, and stop when you feel a sense of emptiness."

The system NPC inserts the needle and opens the infusion channel.

The liquid was turned on to its maximum, dripping steadily from the dripper.

Ji Xiang's heart pounded wildly. It was that simple?!

The flowing liquid symbolizes vitality; if possible, the patient may have a chance!

Ji Xiang immediately helped the system NPC fix the needle with a dressing, and the system NPC adjusted the infusion rate to 50ml/min.

"The difficulty in rehydration after extensive burns is a major challenge in clinical practice."

Because the effective circulating blood volume drops sharply after extensive burns, immediate and rapid fluid resuscitation is the fundamental measure for rescuing those in shock.

However, after extensive burns, the skin is severely damaged, and the blood vessels on the skin surface are severely destroyed. There are few or no veins available for intravenous infusion, and even the remaining skin is a precious donor site that needs to be protected.

After the system NPC finished doing all this, it looked at Ji Xiang and said calmly.

Based on the somber expressions of the people outside the emergency room and the helpless looks of Colonel Wang and General Manager Wu, Ji Xiang vaguely understood the consciousness of the system NPC.

Indeed, it's hard for doctors to accept that a healthy person can die without an intravenous access.

"Deep vein puncture or incision requires skilled operation techniques, strict local aseptic conditions, and is difficult and time-consuming. It is also impossible to replenish large amounts of fluid in a short period of time, which affects the timing of rescue and the effectiveness of treatment."

"Teacher, is there any other way?"

"Bone marrow aspiration is possible," the system NPC said. "However, extensive burns are a contraindication for bone marrow aspiration, so it's not suitable in this situation. Forcing it would lead to serious problems such as infection later on."

"The corpus cavernosum has its own advantages. First, its location is relatively hidden, making it less likely to be burned, the skin is relatively intact, and its anatomical position is relatively fixed, making it easy to puncture."

The corpus cavernosum is composed of many trabeculae and cavities. These cavities are actually sinuses that communicate with blood vessels. The blood sinuses are large and extensive, draining into the deep dorsal veins, entering the pelvic venous plexus, and can directly enter the systemic circulation.

Another advantage is that the corpora cavernosa is surrounded by a tough tunica albuginea, allowing the sinuses to remain open even in cases of insufficient blood volume. This relatively independent and intact tissue structure enables rapid, accurate puncture with a high success rate.

Ji Xiang's vague understanding gradually became clearer as the system NPC explained it to him.

This is much better than veins, especially since the cavernous body is covered by a white membrane, which is an independent tissue structure. This prevents the failure of resuscitation due to collapsed blood vessels throughout the body in hemorrhagic shock.

"Teacher, why isn't this practice being widely adopted in clinical settings?"

"It's quite rare to find a situation where there are absolutely no blood vessels," the system NPC said. "Secondly, this operation may have side effects, so it shouldn't be used unless absolutely necessary."

Ji Xiang nodded.

"Come here."

The simulator was changed, and Ji Xiang put on gloves and began to imitate the system NPC's needle-giving process step by step.

……

"Sir, this is Elder Gu from the capital, a member of the health care team," said Dean Chen of the Second Affiliated Hospital to the city leaders.

We happened to run into this person; although he wasn't from the emergency and critical care medicine department, his reputation in the health care team was quite impressive.

The patient could not be saved. Dean Chen just wanted to use every means to tell the leadership that it wasn't that the hospital hadn't done its best, but that the damage was too severe.

Dean Chen was well aware of the severe consequences of the three deaths.

(End of this chapter)