Chapter 1470: Relying on Improvisation

Chapter 1470: Chapter 1470: Relying on Improvisation

(Thanks to Xuelong Potian, Sterling, Wo Ai Yanyang, Yao Wenzhou, and Mo Ke for their support with monthly tickets)

"Teacher Liu, the bleeding is too severe, we can’t see anything."

Liu Yiqing ran out.

"There’s no other way, we can only go for open abdominal surgery to stop the bleeding. What’s your opinion?" Liu Banxia looked at the patient.

"Do it, save my father’s life." The patient hurriedly said.

"Prepare the operating room, and then get an urgent CT scan. Cui Jia, explain the surgical procedure to the patient’s family and get the consent form signed. Liu Yiqing, you come with me to the operating room first."

After speaking, Liu Banxia headed to the operating room.

Every bit of time saved is important, we still have to wash hands and get dressed, aiming to be ready before the patient is brought in.

Liu Yiqing gave Cui Jia a determined look, then chased after Liu Banxia.

It’s not just about notifying the surgery, but also advising the patient on registration and payment. It’s a series of steps that must be followed.

Of course, the complexity of this surgery is also acknowledged. It’s understandable if the patient can’t immediately pay such a large amount.

As someone brought in for emergency care, preserving life is the top priority.

"Liu Yiqing, I think your skills are already quite good, responding promptly to situations." Liu Banxia said.

"Teacher Liu, if I said I wanted to launch a satellite, it wouldn’t be like this. Are you suspecting an arterial aneurysm?" Liu Yiqing asked.

"Very likely, we’ll see what the CT results are like, then we can determine the surgical approach." Liu Banxia said.

"Not far off, with such severe bleeding, it’s likely. It depends on the location, how easy it is to handle. His son doesn’t seem to understand his father’s condition very well."

"Teacher Liu, why do you say that?" Liu Yiqing asked curiously.

"The patient probably has hypertension, but his son said he only has Alzheimer’s." Liu Banxia said.

Liu Yiqing paused, said nothing, and continued scrubbing with Liu Banxia.

This is indeed an issue, if it is indeed an arterial aneurysm, the patient’s blood pressure is often higher. Even though the CT results aren’t available yet, both are leaning towards the likelihood of an aneurysm.

"Director Liu, how’s this surgery looking, can we make it to the end of lunch?"

Seeing him walk in, Li Liwei asked.

"Hard to say, we don’t know exactly yet, let’s see. Liu Yiqing assured us she would do her best." Liu Banxia said.

Liu Yiqing didn’t know what to say, wondering why she was being forced to take the lead again.

At this moment, the operating room phone rang, and the circulating nurse quickly answered.

"Teacher Liu, the patient has an aortic aneurysm. It’s quite large, extending to the duodenum, now being brought to the operating room." Cui Jia’s voice came through.

"Alright, hand it over to the operating room nurse when the time comes. You scrub in as well." Liu Banxia said, gesturing for the circulating nurse to hang up the phone.

"It’s an aortoduodenal fistula, not easy to handle. Hang in there everyone, lunch break might be tough to catch today." Liu Banxia said.

The patient’s condition is indeed serious, and the surgery is quite challenging.

At this point, Li Liwei also looked at the patient’s CT on the computer and gave a wry smile.

Even though he’s not a surgeon, he’s seen enough. The complexity of this surgery is really high, Liu Banxia needs to think it through carefully.

The patient was brought in at this time.

"Brother Li, leave the patient’s vitals to you, we’ll try to save some time." Liu Banxia said.

"Please, the patient’s condition is quite bad." Li Liwei frowned and said.

"Liu Yiqing, prepare for a laparotomy." Liu Banxia nodded.

"Cui Jia, once we open up, how should we proceed? If you were the lead surgeon, what would you do, give me your most straightforward idea."

"Huh? Stop the bleeding."

Cui Jia, who had just walked into the operating room, was a bit stunned.

"Be more specific." Liu Banxia continued.

"Um... it should be compressing to stop the bleeding, it’s an aortic aneurysm, so compress the aorta." Cui Jia said.

"Alright, then it’s up to you to press later, Liu Yiqing and I will manage the other issues." Liu Banxia nodded.

Cui Jia grimaced, never thought such a challenging task would one day fall on a junior resident like her.

This involves pressing on a vessel, it’s reputedly Teacher Liu’s specialty, and now it’s passed to her? What if she presses incorrectly?

"Don’t overthink it, just below the diaphragm." Liu Yiqing slightly reminded.

Regarding this situation, Liu Banxia didn’t say anything. The challenge for Cui Jia came too suddenly, being able to answer smoothly and daring to take action is a success itself.

The preparations were now complete, and Liu Yiqing began the incision directly.

Cui Jia suddenly became very nervous. Given the current situation, there was no time for her to think it over.

As the abdomen was opened, the patient’s bleeding worsened slightly, and blood pressure started to drop.

However, Liu Banxia did not rush, instead leading Liu Yiqing to stand aside and wait for Cui Jia’s action.

Cui Jia felt her head buzzing, and her whole body tingling. She steadied herself and pressed down with her fingers.

Her eyes remained glued to the monitoring device, watching the blood pressure as she tried to adjust the pressure.

"OK, I think it’s under control, the blood pressure is rising," said Li Liwei.

Cui Jia let out a breath, looking pitifully at Liu Banxia.

"Don’t rush; you need to keep pressing for a while, as this is only a temporary measure. Until the aortic aneurysm is dealt with, the patient won’t be out of danger," said Liu Banxia.

"Pressing on the vasculature requires control over force. It’s not as exaggerated as you might imagine. You’re pressing now, and it’s not that scary, right? Tell me the most direct feeling you get from your finger feedback."

"A bit numb."

Cui Jia spoke her genuine feeling without thinking.

The initially tense and serious operating room atmosphere lightened as everyone couldn’t help but smile at Cui Jia’s words.

Liu Banxia sighed helplessly, "I’m not asking about your personal feeling, but what does the feedback from your finger feel like."

"Oh, I see. It feels like the patient’s vessels are a bit rigid," Cui Jia replied after thinking for a moment.

"Exactly, that indicates severe atherosclerosis in the patient’s aorta. Such aneurysms form when the atheromatous plaques expand," Liu Banxia explained.

"And with these rigid blood vessels, implanting a stent becomes very challenging. Liu Yiqing, find the bleeding point, and be as cautious as possible."

"Alright."

Liu Yiqing quickly got to work.

Even though she was mentally prepared, Liu Yiqing’s operation was still not easy.

The operation needs to be done very cautiously to prevent damage to the atheromatous plaques.

Unfortunately, this patient’s condition was too severe; despite her caution, the worst scenario happened.

Liu Banxia tried to remove some plaques with a clamp but eventually gave up. There was no way to clamp further, reaching the mesenteric artery already.

The atmosphere in the operating room suddenly grew tense.

"Don’t panic, let me think it over," Liu Banxia murmured softly.

His brain worked at full speed to devise a solution in a brief time, combining his observations and forming a new plan.

That’s the headache with emergency surgeries; they don’t give you much time to prepare. You have to act immediately; where’s the time for preparation?

So, many times it all comes down to the emergency doctor’s skill and responsiveness.

"Free the renal vein; maybe we can bypass the damaged plaques and locate the bleeding point," Liu Banxia suggested.

Liu Yiqing gritted her teeth but moved decisively, executing the task without hesitation.

This was the experience accumulated from long-term collaboration, even if unsure of Liu Banxia’s orders, she unwaveringly follows through.

"Wow..., found the bleeding point!"

With Liu Yiqing’s maneuver, Cui Jia exclaimed with delight.

"Suture to stop the bleeding; for now, that’s the best we can do. Artificial vascular replacement is quite invasive for the patient," Liu Banxia nodded.

"Impressive, truly impressive; such astute improvisation is rare," Li Liwei marveled.

"It’s just that I’ve become more familiar with this section of the vasculature. I’ve had some experience with aortic dissection surgeries, and vascular replacements are quite strenuous and costly," Liu Banxia commented.

"This patient, if not for Alzheimer’s disease, could have detected the condition early. At least the pulsatile mass would have been noticeable, allowing timely intervention. It wouldn’t be so troublesome."

Pulsatile masses often indicate vascular changes, or are closely linked to vascular conditions. It’s a meaningful symptom manifestation.

However, Alzheimer’s disease greatly impacts the body. This patient’s timely discovery and hospital admission indeed helped save his life.

Still, for this patient, the impact of Alzheimer’s disease means his future won’t be very bright.

But that’s a conversation for later. The current priority is effectively stopping the bleeding and tackling the aneurysm.

Everything else will take time to explore, especially Alzheimer’s disease. There are currently many patients globally suffering from it, yet no effective new medication has been reported.

Watching Liu Yiqing’s operation, Liu Banxia nodded approvingly, "Very good, keep this momentum going. Let Cui Jia handle the closure, and her workload will need to increase moving forward."

Cui Jia nodded pitifully, her mood still unsettled despite everything.