Chapter 46: Cavernous Body Puncture (Part 1)

Ji Xiang arrived at the Second Affiliated Hospital emergency department at the fastest possible speed.

This System Task was not calm like the ones before; instead, it kept flashing, as if it were an alarm light.

Perhaps this was the difference with an Emergency Task; Ji Xiang did not overthink it, tossed his bicycle aside, and jogged into the hospital.

"Doctor Xiao Ji!" Wang Daxiao beckoned, lowering his voice to call out to Ji Xiang.

"Teacher Wang." Ji Xiang ran over through the crowd, "What's going on?"

At this moment, the lobby of the Emergency Department was chaotic, with only the area in front of the Emergency Rescue Room being slightly quieter.

Several people stood at the entrance with grim expressions, and people were constantly reporting the situation to them.

Among those reporting the situation, Ji Xiang only recognized one person—Zhao Yuanzhang.

Zhao Yuanzhang, who had been like the moon surrounded by stars that day, now looked like the most inconspicuous little star, unable to get close at all.

"Two died on the spot, the others... explosion, fire, 16 burn patients have already arrived." Wang Daxiao sighed, his short, stout body seeming to shrink a little.

With such a serious accident, no one's mood would be good when mentioning it.

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

"There are a few with minor injuries, those with moderate injuries were sent straight to the operating table. Now there is one severe burn patient whose Intravenous Access cannot be established... the person, I reckon, is in bad shape."

Ji Xiang cross-referenced it with the System Task and knew this was the patient "waiting to die" that was mentioned.

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

"Don't go," Wang Daxiao sighed, "It's heavier than imagined, two have already died, and there's one where even a needle can't be inserted. The Anesthesiology Department and Nursing Department have both tried, but it didn't work; they are watching the person slip away."

Ji Xiang was somewhat puzzled.

Seeing Ji Xiang's blank expression, Wang Daxiao knew this little rookie didn't understand what it meant at all, so he explained, "A major safety accident with three deaths requires reporting; the city has already ordered that the patient must be saved."

"Saving them at this point is worse than not saving them," Wu Zong said in a low mood, hanging his head and muttering.

Wang Daxiao shook his head, "Keep your voice down."

Wu Zong sighed; Ji Xiang did not know what kind of things they had encountered to be able to say such words.

But gossip could be pushed to later; the most important thing now was to establish Intravenous Access.

One couldn't just watch someone die, right?

But Ji Xiang didn't even know the most basic situation, so he asked cautiously, "Teacher Wang, what is the patient's condition? Why can't even a needle be inserted?"

"Full-body burns, even the soles of the feet are burned; only the right groin area has a spot where a blood vessel can be seen," Wang Daxiao said, "But there is necrotic skin and blisters. That was the only blood vessel left, and Director Xu from the Anesthesiology Department was the last one to try to establish Intravenous Access."

"And then?"

"Failed," Wang Daxiao sighed again, "The blood vessels of a severe burn patient are precious as life. There was once a burn patient staying in the sterile room of the Burn Department; a doctor was changing the dressing and somehow the Intravenous Access came out, and that doctor was pointed at and scolded by the Director of the Burn Department for a week."

"..." Ji Xiang was speechless; as a rookie, he couldn't feel just how severe the situation Wang Daxiao described really was.

"Go to the operating table and take a look in a while; you'll have to rotate through the Burn Department sooner or later," Wang Daxiao said, "Look at the lighter patients first, so you don't end up unable to handle it when the time comes."

The intention to mentor was very strong here, but Ji Xiang was a bit anxious; he didn't say anything and turned to go to the restroom.

"No manners at all," Wu Zong looked at Ji Xiang's tall back and said with disdain.

"Came too hurriedly, plus the nervousness, the sphincter... holding a bladder of urine, even a god couldn't take it," Wang Daxiao was quite tolerant of Ji Xiang.

Ji Xiang found a quiet place, held his breath, and entered the System Space.

"Teacher, you know about the task, right?" Ji Xiang asked anxiously after entering.

Although the time flow in the System Space was different from the outside, Ji Xiang, this rookie, had already been unconsciously assimilated by that tense and oppressive atmosphere, immersing himself in it.

"I know," the System NPC said slowly, hands behind his back and hunched over, "You go look at the Simulated Human first, then state your treatment opinion."

So it was already prepared; Ji Xiang didn't stand on ceremony with the System NPC and strode into the operating room.

A Simulated Human covered in burns lay on the operating table; Ji Xiang took one look, and his heart turned cold.

So this is what a full-body burn is like.

The Simulated Human was covered in carbonized areas, and the slightly lighter places were all red patches and blisters; there wasn't a single piece of intact skin, no wonder they said a needle couldn't be inserted.

"Generally speaking, Scalp Needle and groin Indwelling Needle are the most commonly used methods for burn patients to establish Intravenous Access," the System NPC explained, "But this patient's injury is severe, and only the pubic area is basically fine. However, there are also many blisters in the groin area; take a look."

Ji Xiang gradually felt helpless.

The System Task was right; there was simply no way to establish Intravenous Access. Except for a palm-sized area on the lower body, the patient had no intact skin anywhere else.

"Teacher, how should this be done?" Ji Xiang asked blankly.

"I will teach you," the System NPC said indifferently, "I showed you the anatomical structure of the Corpus Cavernosum on the first day; tell me about it."

"There are a large number of cavernous sinuses behind the Corpus Cavernosum, which act like valves; stimulating them causes local smooth muscle relaxation, and a large amount of blood is pumped in..."

As Ji Xiang spoke, he suddenly understood what the System NPC meant.

But... Cavernous Body Puncture for infusion? Ji Xiang had never even heard of such a method.

"Teacher, are you saying to perform an infusion through the Corpus Cavernosum?" Ji Xiang asked tentatively, fearing he had misunderstood.

"Mm," the System NPC nodded.

Ji Xiang didn't know whether to laugh or cry.

The Corpus Cavernosum is not a blood vessel!

But logically speaking, it seemed... possible.

However, looking at the helpless expressions of Wang Daxiao and Wu Zong outside, he guessed that even the old hands in the Urology Department had never done such a thing.

"The basic principle is like this; I will perform it once, and you watch," the System NPC put on sterile gloves and began the procedure.

Simple Skin Preparation of the surgical area, cleaning the roots of the remaining hair again.

Afterward, the System NPC began to disinfect the skin around the penis.

Using the index finger and thumb to lift and fix the Corpus Cavernosum behind it, he chose the right side of the Corpus Cavernosum, the lateral area without subcutaneous veins.

"Note, you must avoid damaging the dorsal nerve-vascular bundle and the ventral urethra here."

The System NPC cautioned Ji Xiang when he reached this step.

Ji Xiang nodded; he understood the System NPC's operation. It wasn't highly difficult, just a matter of overcoming a fixed mindset.

What he was curious about was whether it would actually work.

After all, Ji Xiang had never seen, heard of, or even thought of Cavernous Body Infusion.

The System NPC used a No. 6 Infusion Needle, piercing the side of the Corpus Cavernosum at a 45° angle to a depth of about 2cm, and then advanced the needle about 0.5cm after breaking through the White Membrane.

"There is a trick to the needle of the Infusion Set; I won't go into specifics, you should feel it out carefully in the future," the System NPC explained. "45° from the side is the best angle. Given the Patient's condition, inserting the needle 2cm, you will feel a loss of resistance when the needle pierces the White Membrane."

"Pierce the White Membrane by 0.5cm; you can stop once you feel that loss of resistance."

The System NPC inserted the needle and opened the infusion channel.

The liquid was turned to the maximum, dripping in a continuous stream in the drip chamber.

Ji Xiang's heart pounded; it was this simple?!

The continuous stream of liquid symbolized life; if this worked, the Patient might have a chance!

Ji Xiang immediately helped the System NPC secure the needle with a Dressing, and the System NPC adjusted the infusion speed to 50ml/min.

"Fluid resuscitation after extensive burns is a very troublesome matter in Clinical practice.

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

However, after extensive burns, the skin is severely damaged and surface blood vessels are severely destroyed. There are few veins available for infusion, or even nowhere to puncture, and even the remaining skin is a precious donor site that needs protection."

After finishing all this, the System NPC looked at Ji Xiang and said indifferently.

Referring to the gloomy expressions of the people outside the Emergency Rescue Room and the helpless looks of Wang Daxiao and Wu Zong, Ji Xiang vaguely understood the System NPC's intent.

Indeed, for a living person to die just like that because a venous channel could not be established is very hard for a Doctor to accept.

"Deep Vein Puncture or cut-down requires the operator to have skilled technique, requires strict local sterile conditions, and is difficult and time-consuming, making it impossible to replenish large amounts of fluid in a short time, affecting the timing of rescue and the effectiveness of treatment."

"Teacher, is there any other way?"

"You could perform a Bone Marrow Cavity Puncture," the System NPC said. "However, extensive burns are a contraindication for Bone Marrow Cavity Puncture; it is not suitable at this time. If you force it, subsequent infections and the like will be major problems."

"The Corpus Cavernosum has its own advantages. First, its location is relatively hidden, not easily burned, the skin is relatively intact, and the anatomical position is relatively fixed, making it easy to puncture.

The Corpus Cavernosum is composed of many cavernous trabeculae and lacunae. The lacunae are actually sinusoids that communicate with blood vessels. The blood sinus lacunae are large and extensive, draining into the deep dorsal vein, entering the pelvic venous plexus, and can directly enter the Systemic Circulation.

Furthermore, there is another benefit—the Corpus Cavernosum is wrapped in a tough White Membrane, which keeps the blood sinuses open even in cases of insufficient blood volume. It is a relatively independent and complete tissue structure, allowing for fast, accurate puncture and a high success rate."

Ji Xiang's vague understanding gradually became clear following the System NPC's explanation.

This is better than veins, damn it! Especially since the Corpus Cavernosum is wrapped in a White Membrane, it belongs to an independent tissue structure and won't lead to rescue failure because all the blood vessels in the body have collapsed due to Hemorrhagic Shock, making it impossible to insert a needle.

"Teacher, then why isn't it widely promoted in Clinical practice?"

"It is relatively rare to have a situation where there is truly not a single blood vessel," the System NPC said. "Secondly, this kind of operation may have side effects; it cannot be used unless absolutely necessary."

Ji Xiang nodded.

"You try."

The Simulated Human was changed. Ji Xiang put on gloves and began to follow the System NPC's needle-insertion process step by step.

"Leader, this is Gu Lao from the Imperial Capital, a member of the Health Care Group," Chen Yuanzhang of the Second Affiliated Hospital introduced to the city leader.

It just so happened that he was here. Although he was not from emergency or critical care medicine, the name of the Health Care Group was loud enough.

The Patient could not be saved. Chen Yuanzhang just wanted to use every possible way to tell the leader that it wasn't that the hospital didn't try its best, but that the injuries were too severe.

Chen Yuanzhang certainly knew how heavy the consequences of 3 deaths were.

(End of this chapter)