Chapter 315

"Xiao Fang, isn't this a coincidence? We just ordered late-night snacks to eat together." Fang Ziye had just come out of the Emergency Operating Room when he ran into Deng Zhi, the Mediterranean fatty, right at the door.

Deng Zhi was the Chief Resident of the Emergency Surgery Clinic; his chubby build was one thing, but the Mediterranean bald spot on his crown was even purer than his own Master Yuan Weihong's — proof enough that the Emergency Department grinds people down severely.

"Brother Zhi, my appetite isn't small; wouldn't going make you guys go hungry?" It was past the middle of the night; the only places ordering late-night snacks at this hour were probably the hospital and similar units.

As everyone knows, being a doctor is not just brainwork — it's physical labor too.

"Hey, just a craving. Perfect chance to introduce you to a brother and a Sister." Deng Zhi waved generously at Fang Ziye, signaling him to come on over.

After tossing the hand-wiping tissue into the black trash can, Fang Ziye thought for a moment and said: "Let me guess — is it Sister Ning Shuang and Sister Piaopiao?"

Ning Shuang was the EICU Chief Resident, and Guo Piaopiao was the Chief Resident of the Emergency Internal Medicine Clinic; both were female!

However, it seemed quite a few people in the Emergency Department didn't treat Sister Ning Shuang as a girl, regarding her as a pure Grandpa-style tough guy.

"Hey, I said I'd introduce you to a brother — this Frost Grandpa even drinks beer by stomping the can with his foot." Deng Zhi corrected Fang Ziye's wording again.

As it happened, Ning Shuang, who had come out looking for Deng Zhi, heard exactly that; sporting a neat short haircut, she immediately rolled up her sleeves and walked over, speaking in a somewhat rough accent: "Deng Zhi, what do you think you're doing?"

One listen and you could tell it was a Northeastern accent.

"I was wrong, Frost Grandpa..." Deng Zhi hurriedly begged for mercy.

Perhaps because an outsider was present — everyone being Big Fools — Ning Shuang didn't take it seriously.

Fang Ziye treated it as going to mooch a meal.

This was still Fang Ziye's first time eating with colleagues from other departments; although it was a late-night snack, after he entered the Emergency Department's on-call rest room and heard Ning Shuang and Guo Piaopiao's conversation, it was quite explosive.

There was a teen girl with a ruptured fallopian tube, a forty-something woman bringing a teen 'boyfriend' for an abortion at the ER, and someone who got too fancy with positions and dislocated something at night.

Not to mention retrieving ping-pong balls and such...

To sum it up in one sentence: modern people really know how to play.

However, after Guo Piaopiao and Ning Shuang chatted for a while, the long-haired, long-skirted Guo Piaopiao glanced at Fang Ziye; the topic happened to turn to boyfriends and girlfriends, so she asked: "Doctor Fang, do you have a girlfriend?"

Although Fang Ziye was the Trauma Surgery Chief Resident, he had only just taken the post, so the number of people who had met him was still small.

Because the Chief Resident transfer station is the Emergency Department, Deng Zhi and the others had impressions, more or less, of the Chief Residents of every department in the hospital.

Fang Ziye heard Sister Piaopiao's interest at first glance and said with a smile: "I do; otherwise I'd definitely have Sister Piaopiao introduce me to one — with the resources Sister Piaopiao commands, she'd definitely introduce a good one."

Conveying the meaning precisely is enough; as for the flattery afterward, it doesn't really matter.

No one would introduce a girlfriend to someone who already has one based on a single meeting.

Hearing this, Deng Zhi immediately said: "Sister Piaopiao, me me me — I'm single..."

Fang Ziye could tell Deng Zhi might have a thing for Guo Piaopiao, but Guo Piaopiao wasn't too keen on Deng Zhi...

"You? You'd better not ruin my bestie." Guo Piaopiao said it with clear dislike — mainly because Deng Zhi's looks were indeed a bit tragic.

At those words, Deng Zhi turned grief into appetite and started wolfing down his food.

Then Ning Shuang and Guo Piaopiao discussed other topics — like getting wrinkles from staying up late, what cosmetics work best.

This bit of salary all goes into maintaining this face...

Right then, while several people were eating with relish, a thunderous shout came from outside: "Emergency! Emergency! Massive hemorrhage — urgently request Vascular Surgery and Trauma Surgery for emergency consultation..."

Hearing this, all four froze in perfect unison.

Fang Ziye quickly stepped back from the table a few paces and began putting on his work uniform and mask.

Then he said: "Brother Zhi, you guys eat first — someone's calling outside..."

"Fine!" All three threw him pitiful looks.

Actually, the Emergency Surgery and Emergency Internal Medicine ward Chief Residents aren't that busy yet; they only get busy after patients are admitted to the wards.

Fang Ziye didn't waste words; he directly twisted open the rest room door.

Emergency patients with massive bleeding usually request emergency consultation from the relevant specialty for emergency hemostasis; at this point Deng Zhi and the others don't need to join the excitement.

Fang Ziye strode out and at first glance saw bloodstains on the floor at the Emergency Registration Desk, the trail leading toward the Emergency Resuscitation Room.

At the same time, Fang Ziye's consultation phone rang.

Fang Ziye answered immediately and broke into a run: "I'm right at the Emergency Department, arriving now."

He hung up as soon as he finished speaking.

Then he took a disposable examination glove from the right pocket of his white coat, preparing to put it on.

But when he reached the Emergency Resuscitation Room doorway, Fang Ziye discovered that, despite several white coats pressing down inside, blood still seemed to be gushing out.

"Can't hold it — have the Vascular Surgery people arrived?"

"Do we rush to the OR right now?" The pressing doctor's white coat was splattered with blood sprayed by the patient.

Seeing this, Fang Ziye put a glove on his right hand at the fastest speed of his life!

He then quickly stepped to the resuscitation bedside, gave the patient's current condition a rough scan, and knew the situation was extremely bad.

For some unknown reason a sharp instrument injury had occurred; right now a sharp deformed steel fragment remained in the patient's left lower abdomen, having cut through the superficial skin and fat and then into a vessel.

At a glance, this was a left femoral artery injury.

But in reality the patient's bleeding was far from that simple. "Hemostat, open the debridement kit!"

"This isn't a simple femoral artery injury; compression hemostasis isn't working." Fang Ziye quickly instructed the nurse.

Fang Ziye wore a white coat with his newly processed Chief Resident badge hanging; his orders were exceptionally crisp and decisive.

With this status, the assisting nurses didn't hesitate to tear open the debridement kit and the cricothyroidotomy kit, and handed over the hemostat Fang Ziye requested.

The on-duty nurse who had made the emergency consultation call also finished the call and ran over quickly.

Chen Jiameng from the Surgical Clinic, seeing Fang Ziye, said: "Xiao Fang, what do we do? If this bleeding can't be stopped, the patient's gone — this is acute vascular injury blood loss..."

Fang Ziye didn't reply; right now he had no energy to spare for distraction.

His gaze fixed on the steel fragment's approximate entry direction and deformation, analyzing the possible damaged anatomical positions and the internal vascular injuries —

The vascular layout in the lower abdomen is extremely complex: the aorta branches into the left and right common iliac arteries, which further branch into the internal and external iliac arteries.

The internal and external iliac arteries have many branches; the femoral artery is only one of them — this patient's arterial injury is absolutely not a simple femoral artery injury.

Manual pressure hemostasis is only suitable for simple single-vessel injuries; with multiple vessel injuries, the manual pressure hemostasis technique cannot be used to stop the bleeding.

Fang Ziye's current Hemostasis Technique proficiency is Level 4; besides the operation itself, he also has some hemostasis concepts.

Perhaps these concepts are not as formidable as Wu Xuanqi, who is more skilled in Vascular Surgery, but Fang Ziye still relied on his own understanding to make a relatively bold attempt.

The femoral artery is a branch of the external iliac artery, and one of the largest branches at that.

The internal iliac artery's position is closer to the abdominal midline; given the angle of the steel fragment currently embedded in the patient, it should not have caused internal iliac artery damage!

However, this is only speculation.

Nevertheless, even if it is only speculation, Fang Ziye can only treat the speculation as a correct condition.

Directly clamping from the source for temporary hemostasis — that is, through the tract created by this steel fragment, directly percutaneously entering the body to find the external iliac artery and clamp it.

Manually clamping the external iliac artery, as long as the time is controlled within a very short period, the impact caused is almost negligible, and this can achieve hemostasis the fastest.

Many thoughts, but in reality, only five seconds had passed.

Only then did Fang Ziye move: "Based on the patient's current steel fragment embedding angle, the probability of external iliac artery system injury is considered relatively high; I suggest directly clamping the external iliac artery."

While speaking, Fang Ziye directly plunged the hemostat in.

Similar to a blunt puncture, the blunt-tipped vascular clamp, in Fang Ziye's hands, was like a sharp weapon, quickly piercing into the patient's body.

Chen Jiameng at the side heard this and said: "Doctor Fang, you're the professional, you handle it! ~"

"I'll go explain to the family members afterward!"

"Does this external iliac artery system injury belong to your Orthopedics Department's subspecialty or Vascular Surgery?" Chen Jiameng asked.

Specialty-specific treatment — this point must be clarified right now.

Fang Ziye can follow the emergency rescue procedure for emergency avoidance, with rescue as the purpose, temporarily handling it across specialties, but after the temporary handling, it still has to return to the specialty.

Fang Ziye didn't reply, but instead stirred the hemostat inside the patient's body for a while, then after squeezing through several muscle gaps again, the hemostat's distal end opened.

Moving it up and down, feeling that the tube wall he touched was vascular anatomical tissue, only then did Fang Ziye open the hemostat, and then without hesitation clamp it shut.

This kind of manual probing is actually a flexible application of a relatively advanced Physical Examination Technique.

Once Physical Examination Technique reaches a relatively proficient level, even the subtle pulsation of blood vessels can be felt; determining whether it belongs to vascular tissue is relatively simple.

After clamping, Fang Ziye immediately released his right hand, then said: "Doctor Chen, you release the pressure first; if this patient has an external iliac artery system injury, the bleeding should immediately slow down."

"A small amount of oozing is residual blood inside the vessel lumen; this is harmless."

"Oh. Good!" Chen Jiameng let go.

He is an attending physician in Geriatric Surgery; Geriatric Surgery rarely has emergencies, it's just a separately divided subspecialty. Because Geriatric Surgery emergencies are all categorized into common specialty emergencies.

After all, you can't just because he's old, has an aortic dissection, put him in Geriatric Surgery instead of Cardiac Surgery……

After Chen Jiameng stepped back a short distance, he indeed found the spurting blood disappeared, only a small amount of oozing remained.

"The speculation should be correct; this kind of hemorrhagic shock, after the bleeding site is handled, the patient's blood pressure fluctuations will tend to stabilize."

"But blood transfusion is still needed where needed; based on the on-site blood loss, the patient's blood loss has already reached above the shock standard."

While explaining his operation was effective, Fang Ziye continued to warn others not to let their guard down especially.

Everyone observed for a while longer, and finally saw the patient's blood pressure maintain around systolic 85!

It didn't continue to drop — thank heaven for that.

Chen Jiameng immediately said: "Contact the Blood Bank immediately, apply for emergency blood matching, both red blood cells and plasma, the more the better!"

"Tell them, the patient's blood loss is at least 3000ml or more!"

"Establish intravenous access immediately……"

As Chen Jiameng said this, the Emergency Department's own doctors immediately nodded in thanks. And said: "Doctor Chen, Doctor Fang, you've worked hard; besides surgery, we'll properly arrange everything else."

Actually, the Emergency Department's emergency rescue task belongs to the Emergency Department.

But this patient's rescue really had no other method besides hemostasis, and even temporary pressure hemostasis was useless, so the Emergency Department's duty doctor could only seek help from Chen Jiameng.

Chen Jiameng didn't reply; although he didn't help much, he still counted as completing his task.

Heaving a sigh of relief, Chen Jiameng glanced at his white coat already contaminated beyond recognition, gave a bitter laugh, and said to one of the Emergency Department doctors: "Liang Ge, I have to borrow your white coat again; this one's unusable again."

"No problem, our Emergency Department has plenty of white coats prepared, all sizes available." The person called Liang Ge had a very amiable look in his eyes.

Just while speaking, he intentionally or unintentionally glanced at the hemostat's twin rings currently inserted in the patient's body, always feeling that such an operation actually coming from such a young doctor's hands was still too inconceivable.

Only at this time did Fang Ziye answer Chen Jiameng's previous question about disease type ownership: "Doctor Chen, this patient's subsequent surgical handling should be taken over by Vascular Surgery; I've never seen our department handle iliac artery system. If it's purely below the femoral artery, then it belongs to our department."

"Mm, good! ~"

"Thank you, Doctor Fang." Chen Jiameng didn't call Fang Ziye "Little Fang" today.

"It's my duty, Meng Ge……"

Chen Jiameng and Fang Ziye then temporarily went to the Emergency Surgery Clinic to wait!

The situation here still isn't particularly clear; Fang Ziye isn't a god either.

He also can't determine with the naked eye that this patient's subsequent surgery won't need Trauma Surgery's participation.

And when Vascular Surgery's Doctor Mi Qi rushed from the Rest Room to the Emergency Resuscitation Room at the fastest speed, less than one minute had passed since the call ended; this already counts as very timely.

But even so, Mi Qi seemed to feel he had arrived a bit late.

Roughly scanning the hemostat at the patient's lower abdomen, the twin rings outside, the tip deep inside.

Mi Qi's back couldn't help but tighten as he asked: "Who did this?"

This kind of operation, ordinary people in Vascular Surgery can't complete it; he's currently only seen a few professors operate at special time points.

(Chapter End)