Chapter 297

"Director Qiu, what's the situation with this patient?"

The Anesthesiology Department's Associate Professor Qiu was also a Deputy Chief Physician in the department, but the Anesthesiology Director still gave him face by calling him Director Qiu.

"Director Ceng, when the Emergency Department sent him over, traumatic hemorrhagic hypotension was considered, but shock criteria hadn't been met yet."

"After the operating room was formally opened, although there was still bleeding, blood pressure was barely maintained stable thanks to transfusions."

"But now, the Trauma Surgery people have finished both debridement and exploratory surgery, no active bleeding was found, and the patient's blood pressure hasn't come up..." Associate Professor Qiu hurriedly reported the situation to the Anesthesiology Director.

Associate Professor Qiu's build defied absolute description as fat or thin; looking at his belly alone, he should be a big fat man, but looking at everywhere except his belly, he should be a sturdy, well-built fine fellow.

As Associate Professor Qiu explained, the Anesthesiology Director — tall, sturdy, broad-framed, with muscles knotted visibly more impressively than Associate Professor Qiu's, a middle-aged man — instantly knitted his brows tight.

He looked at the two little ones on the operating table and asked, "Since this shock isn't Orthopedics' responsibility, what are the two of them doing?"

Ceng Quanming had a square, guozi-shaped face, a solemn expression and gaze, as if he had experienced countless life-and-death trials.

His tone was steady with a hint of mockery.

Associate Professor Qiu's eyes darkened beneath his flower-patterned cap: "Director Ceng, people from other surgical departments have all consulted already, all saying the shock is unrelated to their own department's disease types."

"Only Orthopedics' open injury remains."

"And now, Orthopedics' surgery is already done, so hasn't it just become a shock etiology investigation?"

"The patient's current blood pressure? Still counts as relatively good." Qiu Yuxuan glanced at the monitor; although he trusted his own technique, Qiu Yuxuan's mood was also very panicked right now.

In the operating room, the patient on the operating table — a patient with an undiagnosed condition and unceasing shock — he knew in his heart exactly how much trouble that would be.

While the Anesthesiology Director Ceng and Associate Professor Qiu stared at each other there, the Surgical Department's Head Nurse finally walked in from outside, but she didn't dare ask about Anesthesiology's trouble, instead she shouted.

"You surgical people haven't even figured out the cause, why did you send a surgery? Look at how you're going to wrap this up now?" The complaining voice entering the door betrayed her forty-plus tigress age.

Fang Ziye heard this, raised his head to glance but didn't speak, instead signaling his fellow trainee Jie Han to continue suturing.

Perhaps because Fang Ziye looked more honest, the Head Nurse came at him again: "Why don't you hurry up and call your superior?"

"How exactly are things supposed to be handled here now?"

Hearing this, Fang Ziye finally said: "How about Teacher you indicate how we should handle the follow-up?"

"I'm not a doctor, why ask me? If asking me works, why do we still need you doctors?" The woman spoke with complete equanimity, not a trace of guilt, instead carrying mockery.

Fang Ziye then lowered his head and said in a low voice: "I thought you were here to consult and guide on surgical indications?"

"What?" The middle-aged woman who always talked back to heaven, earth, and air, to whom even surgical professors rarely gave face, flashed disbelief in her tone.

"Nothing! ~" Fang Ziye lowered his head, continuing to close the wound with Jie Han.

Hearing this, the Anesthesiology Director finally helped out: "Head Nurse, open injury is a surgical indication; Surgery is a major department, Orthopedics' surgical indications are Orthopedics', they still can't be lumped together indiscriminately."

The woman started nagging: "Director Ceng, you still spoil these Surgery people too much; we're all parallel departments, on what grounds do they..."

As the woman showed off her voice, the operating room door opened, and a young man entered; the youth wore black-rimmed glasses, and after stepping through the door, he wanted to rush to the Anesthesiology computer at the first moment to review images again.

Ceng Quanming saw this, looked him up and down: "Which department's teacher are you?"

The youth trembled at this, then said: "Director Ceng, it's me, Vascular Surgery's."

Ceng Quanming seemed to have recognized the other party long ago: "The person your Vascular Surgery sent is you, right?"

"Director Ceng, when you just called, our department's Director Wu really couldn't get away, abdominal aorta and femoral artery replacement! Besides Director Wu, no one in our group can hold the fort." The youth hurriedly explained.

Knowing his sneaky arrival had been caught red-handed, he was only an Attending Physician now, actually not quite qualified to answer a consultation call from a major department director like Ceng Quanming.

"Shock etiology investigation, your Vascular Surgery has the heaviest task load, you need to weigh it well yourself!"

"I just looked at the medical record; when the patient was in the Emergency Department, Neurosurgery, Gastrointestinal Surgery, Thoracic Surgery, Hepatobiliary Surgery, and Thoracic Surgery consultants were all already Attending Physicians." Ceng Quanming reminded the youth to recognize reality clearly.

"Eh, thank you Teacher Ceng, I'll be very cautious." The youth's heart wasn't particularly panicked.

Zhongnan Hospital's Thoracic Surgery and Cardiac Surgery are merged; Vascular Surgery actually mainly manages other major arterial injuries besides thoracic aorta.

And some other minor arterial injuries are actually attributed to various subspecialties.

Besides that, there are some thrombus treatments, which belong to Vascular Surgery.

If it's visceral hemorrhagic injury, this kind of local hemostasis is not within Vascular Surgery's scope, at least not at Zhongnan Hospital.

Specialty-specific treatment doesn't mean Vascular Surgery needs to 'perform' hemorrhoidal vessel hemostasis technique for you.

What the youth could think of, Ceng Quanming could also think of, so he cursed in a low voice.

"Wu Yong this dog thing."

The youth heard this, his eyelids lifted; although he clearly heard Ceng Quanming cursing his own department director, his own group leader professor, he still didn't dare talk back.

The youth honestly began reviewing images, re-diagnosing, then rereading the previous medical record book, looking at others' physical examination records to speculate on the real diagnosis...

The current patient is already on the operating table, impossible to take him down for physical examination again; the current Trauma Surgery operation hasn't neared its conclusion yet.

No one can violate sterile principles.

Finding other occult bleeding points besides open limb injuries right now is the emergency consultation's real task.

Other departments' consultants also arrived one after another.

Although some departments sent professors, some sent associate professors, Ceng Quanming had no temper at all.

Different departments actually also have subspecialty divisions.

Being a professor doesn't necessarily mean being the most skilled.

The whole-hospital grand consultation attendance requirement is Deputy Chief Physician and above, what more could he say.

Of course, just when everyone was arguing heatedly, Fang Ziye and Jie Han, the two of them, were suturing with remarkable composure.

It wasn't that the two deliberately delayed time, just that they didn't dare handle it casually, so in suturing technique, they also went full firepower, pushing the words fast and good to the extreme.

Neurosurgery's consultation hadn't even arrived yet, might not even come.

Fang Ziye had already brought the surgery to a conclusion, covered it with sterile dressing, and said to the anesthesiologist: "Teacher Qiu, our Orthopedics emergency surgery is already complete; if the patient's vital signs are stable, can be sent directly to the ward."

"But if blood pressure is unstable, still recommend transfer to ICU."

"As for communicating with the patient's family, I just heard all you teachers put thought into it, so I..." Fang Ziye explained it like this, then sent Jie Han away.

Fang Ziye, having just been warned by Master Yuan Weihong that morning, naturally wouldn't dally again during a non-Emergency Department task.

This patient might cause a medical dispute and even loss of life.

Fang Ziye definitely wouldn't leave midway; he stayed for the whole process. Even when people from other departments were performing surgery, even after Fang Ziye had finished handling the Orthopedics Department matters, he still insisted on staying.

Seeing Fang Ziye just standing to the side, calm and cautious like a turtle, made many people's anger rise.

Many people's anger wasn't directed at one thing.

This anger wasn't just at Fang Ziye's current caution, but also at the fact that Fang Ziye wasn't ruling out achieving the goal of eating melon with a cautious attitude.

Even more anger: the Emergency Surgery people had to put the Orthopedics Department in its place, putting the Orthopedics Department last to be called for an Emergency Consultation.

Now Fang Ziye was just a purely honest person.

He actually didn't object right away; not an old oil stick, not avoiding his own department's tasks and scope of business, he was directly pulled into the operating room before telling others that shock had nothing to do with Orthopedics.

The hospital implements the First-Consultation Responsibility System.

The Emergency Department is the first-consultation department.

So, during the Emergency period, which departments to invite for consultation and which not to invite is the Emergency Department's power.

The order in which departments are invited for consultation is also the Emergency Department's right.

After Fang Ziye thought other departments in the Emergency Department had finished their consultations and came to consult, he naturally had to undertake the exploration and hemostasis work for traumatic injuries.

Different from Fang Ziye's calmness, Deng Zhi was now a bit panicked.

Although he had fulfilled the duties of the Emergency Department Chief Resident, sending the patient to a specialty department.

But now Fang Ziye sent the patient from the specialty department to the Anesthesiology Department, and the Anesthesiology Department would of course send the patient back to the Emergency Department.

How could requesting consultations and screening specialty diagnoses be the Anesthesiology Department's task?

So, Deng Zhi's hair was no longer flowing.

At this moment frowning, while making phone calls over a wider range, even the Emergency Department Administrative Director came over to help clean up the mess.

The current situation is like this.

All consultations requested by the Emergency Department have been handled, but the true cause of the patient's shock still hasn't been found.

Equivalent to the Emergency Department not having found the right department for consultation.

The patient still hasn't reached the Orthopedics Department ward.

So the patient either belongs to the Anesthesiology Department or to the Emergency Surgery that performs emergency surgery.

Trauma Surgery and Orthopedics Department definitely won't handle consultation matters.

Because Fang Ziye's consultation opinion wrote that the lower limb open injury diagnosis is clear, there are indications for emergency surgery exploration and treatment; if there is vascular injury, hemostasis treatment will be given.

Currently the open injury blood loss is not large; considering non-hemorrhagic shock as the direct cause. Suggest requesting other specialty consultations to assist in diagnosis and treatment.

Fang Ziye only said hemostasis exploration, and did not say correcting shock.

As if Fang Ziye had predicted something in advance, but Fang Ziye couldn't go guide and suggest to Emergency Surgery which specialty to request for consultation.

Moreover, although Fang Ziye arrived last, these opinions needed to be written, but the Emergency Department had already done them in advance, so they didn't take it seriously.

But whether you took it seriously or not, the procedures are correct.

……

Jie Han left, went to the Trauma Surgery true operating room.

And after Fang Ziye finished his own surgery, he continued to stay in the operating room, listening and watching on the side.

Of course, what he heard was basically the nodding and shaking movements and sounds of a group of Associate Professors and attending physicians.

"This is strange, right?"

"According to the current CT Plain Film display, there is no bleeding focus in the chest and abdomen?"

"Could it not be hemorrhagic shock?"

"How could it not be hemorrhagic shock? The essence of all shock is hemorrhagic..." someone began to educate and give a lecture.

But no one objected; those whose professional titles could reach this level theoretically couldn't have problems. Some basic theories had been soaked in for ten or twenty years; how could they be wrong.

The definition of shock is absolute or relative insufficiency of blood volume.

CT did not show a bleeding point, but?

Shock still exists.

Watching his own surgery end already having been five minutes, everyone still had no conclusion.

Fang Ziye was also helpless; after all, he didn't want to cause trouble for the matter.

The function of Knowledge Points lies in using them.

Using them on any patient is using them, because the final result is improving his own skill level and proficiency.

So, Fang Ziye could only raise his CT Reading Technique level by one more level.

Immediately, CT Reading Technique reached Level 5 proficiency.

Then Fang Ziye was again by the computer, watching an unknown Associate Professor flipping through the patient's CT reading results over and over.

Roughly looking, there was no bleeding focus.

Looking more meticulously, there was still no bleeding focus.

Looking more meticulously at the blood vessel lumens between various organs, the shapes were actually fine, with no symptoms such as rupture.

So?

It really isn't hemorrhagic shock?

But if it isn't hemorrhagic shock, why is the patient's blood pressure so low?

The blood oxygen level isn't high either.

Cardiac output is also fine? The patient already had cardiac ultrasound monitoring during surgery.

Then, under such circumstances, there can only be other problems.

What kind of problem was that?

After a while, when Fang Ziye examined the abdomen again, Fang Ziye finally had a sudden realization.

Alright, so that's how it is.

Every damn one of us fell for the lamp-black effect.

Everyone only paid attention to the bleeding, and didn't consider relative hypovolemia.

Even more so, they didn't consider an extremely low probability.

The possibility of aortic dissection discovered after CT.

Fang Ziye then suggested: "Old Brother Deng Zhi, why don't you have that Vascular Surgery teacher explore the abdomen carefully again?"

"What?" Deng Zhi's mind was in a mess right now, he simply didn't hear clearly what Fang Ziye was saying at all.

"I said, why don't we do a bedside CT again, or do an abdominal vascular ultrasound?" Fang Ziye gave a more direct and simple suggestion.

"Bedside CT operation in the OR is very difficult, ultrasound has no difficulty, what diagnosis do you guess?"

"After the patient fell into a coma, then encountered aortic dissection."

"Or it could be said to be traumatic, delayed aortic dissection." Fang Ziye suggested.

"That's impossible! ~"

"How could dissection not be diagnosed, the Vascular Surgery people have looked over it many times already."

"We also often see dissection imaging, more so, the patient even had CTA." Deng Zhi almost immediately refuted Fang Ziye's suggestion.

"Then do an ultrasound, anyway there's nothing else to do now." Fang Ziye hastily took a step back.

Surgery has ended, no need to mind sterile principle.

So, Anesthesiology Department's Associate Professor Qiu Yuxuan also really explored the patient's abdomen, and then the ultrasound probe went on and discovered the blood vessel's lumen diameter wasn't quite right...

On the spot, almost everyone was stunned.

Then looking at Fang Ziye who made this suggestion, Fang Ziye had already stepped open the sensing door and left the operating room, leaving only an honest back view.

(Chapter End)