Chapter 685

Stars dot the night, the moon hangs like a wheel.

At nine in the evening in October, the dampness on the Enshi mountains was heavy; under the lights, mist caged the air, forming gorgeous light pillars under the illumination.

After Chen Song's condition temporarily stabilized, Fang Ziye and Nie Mingxian couldn't help much staying inside the consultation room, so they stepped out for a breather.

Nie Mingxian took a sip of cold tea, gulped down several mouthfuls with a gurgle, his brow deeply furrowed, turned his head to look at Fang Ziye, voice low: "Ziye, you tell me, today's incident — was it Dean Chen's instinctive spontaneous symptom, or did he needle it out himself?"

Fang Ziye shook his head; he also took a sip of tea, tasted it was cold tea and put the teacup down, reopened a bottle of mineral water: "From your and my perspective, what we see looks like nothing but the occult."

"Do you understand Chinese medicine?"

"Anyway, I don't."

In years past, some scholars advocated integrating Chinese and Western medicine to treat disease. But the reason Chinese-Western integration failed to develop on a large scale is because modern medicine and traditional medicine doctors both find each other's theories 'profoundly abstruse'!

"Modern medicine insists all disease mechanisms be concrete and minute, examining local lesions, checking blood markers."

"Chinese medicine's pattern identification emphasizes the whole, the four examinations combined, integrating yin-yang, five elements, five viscera, meridian systems..."

Nie Mingxian shook his head with a sigh: "If you say it's fake — if Dean Chen really caused all this by stimulating himself with needles, our learned theories have no way to explain him."

"If you say it's completely real?"

"Judging by the state just now, without ECMO and angiographic intervention, I think Dean Chen would certainly be dead."

"Hush—" Fang Ziye hurriedly lifted the mineral water bottle, made a silencing gesture at Nie Mingxian.

This is Enshi Sanatorium; inside and out, most people are Chen Song and Chen Guangbai's 'direct lineage'; you saying Chen Song should've died long ago, if idle ears hear it, it's no good.

Nie Mingxian continued: "Let's make a hypothesis: if Chinese medicine's corresponding theories are true, then Dean Chen's ordeal won't be so easily reversed; I'm afraid there's still a long period of time to be busy."

Fang Ziye nodded: "Result measurable but process unmeasurable — also a form of ignorance."

"Dead pulse?"

"Even if today Dr. Chen Guangbai and Dr. Wang Qishan and others' needling of acupoints proved local acupoint stimulation can alter the body's microenvironment, it still can't find a better explanatory path or solution for Dean Chen's current situation."

"Because I've heard, Chinese medicine's acupoint stimulation — different force, different depth, produce different effects; if you truly want to research it deeply, without a hundred-odd years, you simply can't get in the door..."

"Not to mention the chain reactions between acupoints." Fang Ziye's research thinking is extremely sharp, so he knows what Chen Guangbai and the others want to do.

It's just that Chen Guangbai and the others at most have only proven the phenomenon of efficacy; how it's effective, how the chain of efficacy works — these questions fundamentally can't be answered.

"I personally still feel, if you want to use modern medical thinking to interpret Chinese medicine, at current tech level it still belongs to violent interpretation, which is inadvisable." Fang Ziye is not optimistic about the 'research' Chen Guangbai and the others are doing!

Nie Mingxian said: "Even if inadvisable, someone has to do it; without trial and error, it can never begin."

"Rest a bit first; I feel there may be more than one hard battle."

"Actually, Dao-heart collapse isn't a bad thing; at least it makes us constantly hold reverence."

"Only pity you and I aren't ICU people, so we can't immersively feel the helplessness of lives slipping away one by one."

The ICU differs from the Emergency Department; ED deaths are all very violent and clean-cut.

Dead is dead, alive is temporarily alive.

As for the 'routine monitoring' after resuscitation, it has nothing to do with Fang Ziye and Nie Mingxian.

Perhaps some are resuscitated to stable vitals in the OR, then pass from other special circumstances — that also doesn't land on Fang Ziye and them as 'blame'!

As long as it's not death from hemorrhagic shock on the operating table, the cause of death mostly has nothing to do with the surgeon.

Fang Ziye and Nie Mingxian ate a little something, then found two beds in the courtyard's staff rest area, wrapped in blankets, and fell asleep.

Surgery is not merely physical labor; there's also the brain's crazy high-speed operation and exhaustion in the short term.

23:08 ICU.

The cardiac monitor's green waveform twisted into sawteeth in the darkness; the buzzer blasted in the silence.

Luo Tingzhu abruptly lifted her head from the anesthesia record instrument; six monitoring screens' cold light interwove into a net in her pupils, pupils contracting to needle points in the screen glare.

The moment she hit the sedation pump's pause button, Chen Song's withered chest suddenly heaved violently; the blue-white striped patient gown morphed into the rescue cart's rotating beacon under the monitor's red light.

"Teacher Tan. Polymorphic VT! R-on-T!!" Luo Tingzhu's warning blasted in sync with the monitor alarm. Her voice like a scalpel slicing air, left hand hitting the sedation pump stop, right hand already gripping the defibrillator handle.

Fang Ziye slammed open the ward door; Chen Song's withered wrist trembled in his palm: "Pulse conduction velocity slowing, peripheral circulation failure!"

"200J sync ready!" Tan Mengbai yanked open the patient's gown, the motion throwing static sparks.

Defibrillator pads precisely adhered to right sternal border and apex; his curly temple hair reflected blue light the instant Luo Tingzhu held the defibrillator and discharged: "Clear!"

Chen Song's body bounced on the bed then fell; the ECG waveform briefly returned to sinus rhythm, then twisted again into sawteeth.

"VT! — Continue defibrillation." Tan Mengbai said.

"Norepinephrine combined with dopamine pump in!" Tan Mengbai rapidly instructed the nurse; common rescue drugs need no dose specified.

"Respiratory cardiac arrest!"

Fang Ziye produced the ultrasound probe, swept the carotid artery; elastography showed vessel wall hardness comparable to rock strata: "On ECMO, now!"

Nie Mingxian tore open his lead apron's metal buckle, the sound piercing the silence; ECMO tubing gleamed cold under the emergency lights.

As he rotated the 14Fr cannula into the femoral artery, dark red blood suddenly surged out in a foamy vortex: "Distal perfusion cannula!"

Fang Ziye sutured the silicone tube with precision like joint replacement; the 3mm balloon catheter under the microscope resembled a transparent centipede.

"Esmolol 0.5mg/kg/min, QT interval 520ms!" Luo Tingzhu's voice flat as ECG paper...

Under the shadowless lamp, Li Yongjun's No. 11 scalpel incised the femoral artery at a 45-degree angle; blood sprayed onto the lead glass, blooming fan-shaped.

"15Fr cannula." Li Yongjun left hand held mosquito forceps to hold open the vessel incision, right hand rotated the heparin-coated cannula in, movements precise as assembling spacecraft components.

Fang Ziye adjusted interpupillary distance at the microscope; 8-0 polypropylene suture wove a spiderweb on the perforating vessel wall.

"Flow 50ml/kg/min, speed 3000." Nie Mingxian tapped the ECMO control screen, suddenly frowned: "Venous drainage turbulent flow, Hct 28%, immediately transfuse Type O red blood cells 2u!"

"ECMO-monitored DSA thrombectomy!" Fang Ziye shouted.

Li Yongjun still looked at Fang Ziye; at this moment he trusted Fang Ziye's operational precision more.

Luo Tingzhu, assisting on the side, hearing the order, immediately injected contrast agent again into Chen Song's body; Chen Song's heart and great vessels visualized again.

"Right coronary artery distal occlusion, left anterior descending artery distal occlusion!"

"Interventional thrombectomy!"

"On ECMO, SpO2 96%, BP 112/85 mmHg." Professor Tan Mengbai gave everyone the strongest reassurance at just the right moment!

Chen Song's resuscitation was extremely fast; ECMO was initiated at the first moment, so oxygen saturation and blood pressure levels did not fluctuate arbitrarily, and there was fundamentally no need to consider the five-minute golden resuscitation window.

Fang Ziye sweated profusely inside his lead apron; the DSA 3D imaging showed the left atrial appendage thrombus floating like a ghost jellyfish.

"Watchman occluder in position!" Fang Ziye replied.

Fang Ziye was the operator at this moment; he trusted Professor Tan Mengbai and Cardiology Professor Yang Fenggen's suggestions; he only executed.

"Release!"

The DSA 3D image cast a ghostly blue shadow on the lead glass; Fang Ziye manipulated the guidewire through the trabeculae carneae of the atrial appendage, the tactile sensation like advancing an intramedullary nail through a bone cavity.

The instant the Watchman occluder deployed, the 4mm thrombus suddenly contracted into a ball.

"Switch to catheter-directed thrombolysis!" Yang Fenggen's voice was calm but urgent.

As Fang Ziye advanced the microcatheter close, the pulsed spray of rt-PA bloomed into silver fireworks under X-ray.

Luo Tingzhu said: "D-dimer breakthrough 10000 mg/L!"

"There's also a thrombus in the right lower limb vein!"

"Place the filter first!" Fang Ziye reacted swiftly once again.

After atrial fibrillation, thrombi wander chaotically and may lodge in any position.

Once a venous thrombus dislodges, it either causes pulmonary embolism or may possibly return to the heart and cause embolism there.

Intravascular ultrasound showed a needle-shaped hyperechoic focus at the core of the lower limb venous thrombus — precisely the Han City stimulation needle Chen Guangbai had embedded at Zusanli yesterday...

Fang Ziye: "..."

Nie Mingxian and Li Yongjun, who could likewise understand what was inside, also stared at each other in dismay, but none of them spoke idly.

Now was not the time for complaints and accountability; solving the problem was the only thing to do.

Why it appeared here was not important; what mattered was resolving its existence.

"Pause!" Nie Mingxian crunched his third mint candy and projected the fused CT image: "Stainless steel acupuncture needle tip 1.2mm from thrombus."

"Switch to contact thrombolysis." Fang Ziye brought the microcatheter close to the thrombus; his hand was steady as a robotic arm when injecting rt-PA.

"ACT 280 seconds! Halve the thrombolytic dose!"

The monitor showed APTT drop from 280 seconds to 210 seconds. The real-time HPLC monitoring curve and thromboelastography intertwined on the screen into a DNA double helix.

When the last thrombus was removed, only then did Fang Ziye and Nie Mingxian heave a heavy sigh of relief.

Luo Tingzhu adjusted the cerebral oxygen monitoring probe, then suddenly turned the propofol target-controlled knob: "BIS 45, EEG burst suppression."

She increased the norepinephrine pump rate by 0.02 mg/kg/min; the warming blanket maintained core temperature at 36.5°C.

When Fang Ziye examined the femoral artery incision, he found the exudate carried the bitter taste of Angelica sinensis, but Fang Ziye didn't say much; a person's faith is a person's life, perhaps even more important than life.

"Urine output 30 mL/h." Tan Mengbai stared at the Foley catheter.

"Membrane lung transmembrane pressure gradient 120 mmHg!"

"The patient's vital signs have returned to normal!" Tan Mengbai said.

"Thank you for your hard work, Professor Tan, Professor Li, Professor Fang." Chen Guangbai bowed slightly.

During the resuscitation, he didn't utter a word, precisely because he was afraid of disturbing Fang Ziye and the others' resuscitation process, causing an unforeseeable accident.

Neither Tan Mengbai nor Li Yongjun replied; they still stared intently at their respective screens, not daring the slightest negligence.

If it were just an ordinary patient, they would have let down their guard long ago, but obviously, Chen Song's current situation cannot be generalized by common sense.

"Professor Fang, the test results are out..." A nurse walked to Fang Ziye's ear and whispered.

Intravascular OCT showed the treated vessel wall covered in nano-scale crystal lattice, completely identical to Chen Guangbai's acupuncture needle coating.

In the electron microscope lab, ECMO bearing debris and thrombus crystals were found to have overlapping energy spectra; metal components included rare lanthanide elements.

"Mm, noted."

"Should be fine." Fang Ziye actually didn't know if it was fine or not; he could only try his best to reassure everyone.

Whether Chen Song lives or dies now, accountability won't fall on individuals!

After Chen Xiqian heard the sounds inside gradually cease, she hugged the "Pulse Classic" and slowly squeezed into the consultation room; Fang Ziye noticed the "Shrimp-swimming Pulse" illustration in the ancient text in her hand.

Perhaps due to nervousness, Fang Ziye's perspective even produced a hallucination; it seemed the pattern of this 'Shrimp-swimming Pulse' overlapped with Chen Song's vascular image on the holographic screen.

But when Fang Ziye looked more carefully, it was indeed just his own visual afterimage.

"Flow readjusted to 55 mL/kg/min!" Li Yongjun's voice sounded slightly muffled under the lead apron; the ECMO centrifugal pump's hum suddenly turned gentle.

Fang Ziye palpated the 'Shrimp-swimming Pulse' stair-step tremor beginning to weaken; ginkgo leaves outside the window penetrated layers of buildings, floating down; the light cast one side golden yellow, the other side impossible to discover.

Chen Guangbai withdrew the stimulation needle from Zusanli; the nano coating shimmered with iridescence in the sunlight.

Chen Guangbai glanced at Fang Ziye; his expression and gaze were both slightly complex.

Even if he was unwilling to admit the stimulation needle had fractured into the blood vessel, the broken end Fang Ziye retrieved from inside the vessel matched the needle's broken end perfectly.

"Perhaps my technique wasn't good enough." Chen Guangbai murmured.

"Patient electrolyte levels normal, no water-electrolyte imbalance, heart rate has returned to sinus rhythm."

"If subsequent vital signs remain stable, we can appropriately consider weaning at the right time." Luo Tingzhu carefully performed her little anesthesiology assistant duties, no longer coveting other tasks.

Being able to take charge of anesthesia monitoring for Chen Song was an extremely beneficial tempering for her growth.

Suddenly, right at this moment, Fang Ziye, who had been staring at the screen, suddenly gripped the ultrasound probe control handle tightly!

Immediately after, Fang Ziye's hand rotated to the right, while his left hand pointed at a certain spot!

On the screen, a 4.1mm thrombus was passing through the patent foramen ovale, precise as a bullet through a keyhole —

"Right-to-left shunt!" He hit the freeze key; the ultrasound image showed the thrombus head had entered the left atrium!

"Prepare for cerebral artery thrombectomy, Anesthesiology prepare for deep sedation!"

The moment Fang Ziye spoke, his scalp began to tingle, because he didn't even know where this thrombus ultimately came from!

But right now is not the time to get to the bottom of things; when a problem is encountered, the first thing to do is solve the problem! ~

If Chen Song's problem were truly that easy to solve, then Chen Guangbai and the others would fundamentally not dare to use Chen Song as an experiment——

Upon hearing this, Li Yongjun and Nie Mingxian and the others felt their scalps begin to bind tightly.

Under contrast monitoring, it is not unexpected for Fang Ziye to discover the thrombus, but to be able to capture its thrombotic trajectory this quickly — this skill is simply unbelievable.

However, Fang Ziye always inadvertently makes people doubt life.

"Nie Mingxian! ~" Li Yongjun shouted loudly at Nie Mingxian, urging him to hurry and enter the state.

Upon hearing the sound, Luo Tingzhu immediately adjusted the remifentanil target concentration to 0.7mg/kg/h, the bispectral index stabilized at 60.

She glanced at the cerebral oxygen saturation monitor: "Left rSO2 42%, right side 58%, prepare mild hypothermia."

When the cooling blanket activated, the sound of refrigerant flowing and the hum of the ECMO centrifugal pump formed an eerie resonance.

Nie Mingxian pointed at the DSA real-time imaging: "The thrombus turns at the brachiocephalic trunk bifurcation!"

Enhanced angiography shows the thrombus that should have entered the common carotid artery actually reversed and rushed toward the vertebral artery opening.

For safety's sake, Fang Ziye had previously placed stents in the carotid artery and the superior and inferior vena cava, precisely to avoid limb thrombi returning to the heart, arterial thrombi entering the brain and heart.

As long as these few key positions are guarded, other places, even if embolized, can also be not urgent! ~

Under such circumstances, even if a thrombus occurs suddenly, they can once again adapt move by move.

This is the benefit of having advance preparation.

It's just that the medical material cost and manpower cost are considerable; if not for special circumstances, it is fundamentally impossible to achieve such comprehensive prevention.

Moreover, general people also cannot afford this kind of medical expense.

Fang Ziye immediately sent the 6F Navien catheter (Medtronic) into the radial artery nearby; the hydrophilic coating on the tip of the microguidewire (Traxcess 14) glowed with blue light under X-ray.

When the microcatheter crossed 0.5mm past the thrombus, he pressed the release button of the Solitaire FR 4×20mm stent: "Deployment time limit."

"Negative pressure aspiration pressure -28kpa." Nie Mingxian monitored the Penumbra aspiration system, suddenly discovering the thrombus fragments in the collection canister presented a layered structure — the core was a dark red clot, the outer layer wrapped in a fibrin network with a mother-of-pearl luster.

"Retrieve the stent!" Fang Ziye withdrew the catheter at uniform speed; intravascular ultrasound showed the thrombus volume captured inside the stent reached 82mm. Luo Tingzhu's voice came from the walkie-talkie: "Left rSO2 rose to 51%, but TCD shows the middle cerebral artery flow speed suddenly increased to 210cm/s."

"Capture successful! ~" Seeing Fang Ziye retrieve the thrombus, Nie Mingxian's tone carried joy.

After doing the preoperative preparation well, now it is not them waiting by a tree stump for a rabbit to solve the thrombus embolism, but they can capture the moving thrombus anytime.

This is equivalent to an offense-defense reversal in the battle for life and death!

If under such thorough preparation, Chen Song's life is still lost, then only one point can be verified.

Dead pulse must die, irreversible! ~

Even to verify this point, Nie Mingxian and Fang Ziye the two of them must figure out: the dead pulse felt by traditional Chinese medicine, in the end, will in what kind of way, understandable by modern medicine, kill this person Chen Song!

(Chapter End)