Chapter 384: Low-Probability Event

"Old Lu, the patient's condition..." The director of the Respiratory Medicine Department didn't finish the sentence, frowning as she looked at Lu Gang.

The anesthesia machine couldn't even support the patient's breathing; the blood gas analysis values were likely extremely poor.

"Director, the blood gas analysis is back!" A junior doctor rushed in holding an A4 sheet of paper.

The director of the Respiratory Medicine Department took the sheet and glanced at it.

pH: 7.104, PCO2: 89.4mmHg (1mmHg=0.133kPa), PO2: 47mmHg, BE: -2mmol/L, HCO3: 28.0mmol/L.

The data made her feel it was extremely tricky, and she handed the sheet to Lu Gang.

The patient's state was very poor, so poor that the anesthesia machine could barely support them.

If they were to force a bronchoscopy as Lu Gang suggested, it wasn't impossible, but there were risks after all, and most importantly, there was no guaranteed benefit.

Lu Gang glanced at the lab report and subconsciously raised his hand to sweep that strand of hair to the top of his head, pretending he had a thick head of hair.

"Have you all studied the document issued by the Medical Affairs Department?" Lu Gang asked an irrelevant question.

"What?" The director of the Respiratory Medicine Department was taken aback.

"A while ago, a patient came to complain that the hospital had prescribed him fake medicine." Lu Gang wasn't in a rush; he watched the patient's monitoring instrument and began to "gossip."

"..." The director of the Respiratory Medicine Department didn't know why Lu Gang was talking about this at such a critical moment of resuscitation.

But everyone knew Lu Gang's diagnostic level and his shitty temper, so the director of the Respiratory Medicine Department didn't want to court disaster.

"That complaining patient would look back every time he finished defecating, and nobody knew why. He was taking oral Adalat. I ask you, what would be in the stool?"

"The hydrogel shell of the Adalat," the director of the Respiratory Medicine Department replied.

"We explained it for a long time back then, but the patient just wouldn't listen. So, I drafted it, Bai Chuzhang reviewed it, and it was issued to every department, primarily the Circulatory Internal Medicine Department. In the future, when prescribing Adalat, you must explain the pharmacological effects clearly to the patient and the Family Member."

"Uh..."

"The antihypertensive medication this patient is taking orally is also Adalat," Lu Gang said.

The director of the Respiratory Medicine Department seemed to recall something, but she dismissed the answer in the blink of an eye.

"Old Lu, are you saying that when the patient took the Adalat orally, they aspirated it into the airway, and then the shell got stuck?"

"Yes!" Lu Gang's eyes and his bald head simultaneously radiated a faint luster.

"Impossible!" the director of the Respiratory Medicine Department said. "If it were Adalat, it wouldn't block it that tightly..."

"Neither your word nor mine counts. Prepare the Bronchoscope, let's take a look," Lu Gang said with a wave of his hand, leaving no room for doubt.

"That..." The director of the Respiratory Medicine Department hesitated slightly.

"I'll handle Bai Chuzhang," Lu Gang said, giving the director of the Respiratory Medicine Department a sense of reassurance.

Although the director of the Respiratory Medicine Department didn't believe it, since an "Expert" in the hospital had offered an opinion and she had no better solution, she could only treat a dead horse as if it were alive and give it a try.

She went to get busy, and after Lu Gang made a phone call to Bai Chuzhang, he pulled Ji Xiang to a quiet spot.

"Doctor Xiao Ji, I also feel it shouldn't be the case, but there is no other explanation besides the Adalat shell blocking the patient's airway. What do you think about this?"

Lu Gang didn't care about his face at all and asked very bluntly.

"One pill might not, but what if it's two?" Ji Xiang said.

"!!!"

"The anesthesia machine provides ventilation with relatively high pressure; the more it blows, the tighter the affected side gets blocked. If there were only one shell, it wouldn't be this bad, but if two Adalat shells appeared together, it could very likely lead to the current situation."

"But the probability of two pills being aspirated at the same time is too low."

"Not at the same time," Ji Xiang interrupted Lu Gang. "I estimate there is a high probability that it was caused by two separate aspirations."

Lu Gang fell silent; even so, the probability of such a thing happening was truly not high.

"The patient has a history of cerebral infarction, has a certain degree of swallowing dysfunction, and is bedridden long-term. If nursing care is improper, aspiration occurs very easily."

"He might have had other medications—such as Diovan, etc. —aspirated into the airway at the same time, but because they are all soluble, only the Adalat shells were found in the airway."

"Although the possibility of two Adalat shells blocking the airway is not high, we still have to take a look."

"Looking at the scans, I also feel there is a problem," Lu Gang mused.

"Let's try it," Ji Xiang smiled, encouraging Lu Gang.

Lu Gang was stunned. It seemed backwards; he should be the one encouraging a clinical rookie like Ji Xiang, so how did it turn into him being encouraged?

However, having been in the medical team for a while, Lu Gang had more or less gotten used to Ji Xiang's way of taking charge.

Habit is a terrifying thing; it works imperceptibly, making everything that was originally unreasonable seem logical.

"Then I'll go give it a try," Lu Gang said.

The two returned, and after waiting a while longer, the director of the Respiratory Medicine Department came back with the signed form and began preparing the Bronchoscope equipment.

Because the patient was immobile and hooked up to many machines, she pushed the portable Bronchoscope directly in.

First, she used Tetracaine to provide Local Anesthesia to the patient, then the director of the Respiratory Medicine Department guided the Bronchoscope through the patient's nasal cavity to the pharynx, passed the glottis, and pushed it down bit by bit into the main airway.

The patient had a lot of phlegm, so she suctioned it as she went.

"Director Tang, how did you explain it to the patient's Family Member?" Lu Gang didn't do the work himself; his hands-on ability was almost zero, as he was only proficient in theory and diagnosis.

So Lu Gang watched the Bronchoscope screen and chatted with the director of the Respiratory Medicine Department.

"I didn't dare say there was a foreign object in the patient's airway; it would be hard to explain if there wasn't one. I just said we were doing a bronchoscopy to suction out the blocking phlegm."

The *shhh-shhh* sound of the Suction tube made Ji Xiang feel somewhat uncomfortable, as if that tube were stuck in his own oropharynx, making him feel flustered and short of breath, his blood oxygen saturation dropping significantly, and he even vaguely felt like he had altitude sickness.

"It still takes a veteran to step up," Lu Gang said with a feigned relaxed smile.

"It's all because of you, insisting there was an Adalat shell and that we had to do a bronchoscopy," the director of the Respiratory Medicine Department complained while performing the bronchoscopy and keeping an eye on the patient's blood oxygen saturation.

If the blood oxygen saturation were to drop suddenly, they might have to stop the procedure.

But the "accident" still happened—as the Bronchoscope in the director of the Respiratory Medicine Department's hand moved downward, an Adalat shell, "wrapped" in respiratory secretions, appeared in the surgical field.

"!!!" The director of the Respiratory Medicine Department was horrified. "Old Lu, there really is one!"

"Let me see, let me see!" Lu Gang leaned in and took a look.

Just as expected, Lu Gang's mind was instantly set at ease, and the demeanor of a superior Doctor overflowed from him.

"I told you so."

The director of the Respiratory Medicine Department stopped nagging, used the instrument to extract the shell of the Adalat, and only then let out a long sigh of relief.

"Continue," Lu Gang said.

"It's already been extracted, what else is there to continue?" The director of the Respiratory Medicine Department prepared to quit while she was ahead; she looked at the Cardiac Monitor, and the Patient's blood oxygen saturation had already recovered.

The director of the Respiratory Medicine Department was quite satisfied with this; at the very least, the Patient's critical state had been resolved.

(End of chapter)