Chapter 984: then translation of chapter title

A family member lifted a leg and kicked; the obstetrician reacted quickly, sidestepped to avoid, but had to let go of the hand holding the stretcher.

"As long as I've been here, if anything happens you have to take responsibility!" the old lady shouted, pointing at the obstetrician's nose. "You're dodging responsibility! And you claim to save lives and heal the wounded—your conscience has gone to the dogs!"

"……" Zheng Ren was speechless.

"Don't send her away; a C-section is still possible now. The time you mentioned simply won't work!" The obstetrician didn't argue with the old lady, tried to grab the stretcher, but was shoved aside by someone else.

Seeing the elevator arrive, they pushed the stretcher inside, and the noise outside the operating room gradually faded.

But this is only the beginning.

Seeing that persuasion failed, the obstetrician immediately called the director and the Medical Department, explaining the situation while rushing downstairs to change clothes.

Yes, this is only the beginning; more trouble lies ahead.

The obstetrician and Zheng Ren crossed paths; Zheng Ren stepped aside to let her pass, watching her rush off, feeling helpless.

Not believing the big tertiary hospital's advice, they insisted on going to a private clinic or an underground black clinic for delivery. The fetus already showed signs of unstable heart rate, yet they still wanted to wait several more hours before giving birth…

It sounds absurd, but this is the fact.

Zheng Ren shook his head; some things cannot be solved just by high medical skill and level.

However, Zheng Ren knew in his heart that this kind of thing absolutely couldn't be solved by himself; he could only look on and let it be.

He found the second-hand item Su Yun mentioned, opened the sealed door, and went inside.

"Boss, what's happening outside?" Su Yun stood at the assistant's position, while an elderly trainee doctor was squeezed aside by him.

"What's the situation with the pericardium?" Zheng Ren didn't answer Su Yun's question, but turned it back on her.

"Gas-fluid pericardium—rare, huh?" Su Yun said with a chuckle.

Zheng Ren's heart stirred—gas-fluid pericardium? Why didn't the system give a diagnosis?

He glanced at the patient; the last item on the system panel showed a diagnosis of gas-fluid pericardium.

This is…

The patient is damn lucky! Zheng Ren thought.

Usually pericardial effusion is relatively common; traumatic cases are very dangerous. Zheng Ren had encountered a few such cases in Hai Cheng, requiring emergency thoracotomy, directly opening the pericardium under vision to decompress.

However, pneumopericardium is uncommon. Traumatic pneumothorax combined with pericardial rupture, without damaging major vessels, is a reasonable source of pneumopericardium.

Also, it can result from inadvertent injury during anesthetic intubation or mechanical ventilation.

Zheng Ren knew that in the emergency department the system panel had no diagnosis of gas-fluid pericardium, but it appeared on the operating table, possibly due to mechanical ventilation.

"Have you done it?" Zheng Ren asked.

"We're repairing the diaphragm; the tension is especially high."

"Boss Zheng, I'm here." Fang Lin put down the needle holder, turned back and smiled.

Zheng Ren didn't speak to Fang Lin; he stepped closer and glanced at the surgical field.

The diaphragmatic atrophy was quite obvious; my earlier judgment was still quite accurate.

The right diaphragm had already been sutured with the help of a patch; judging by the tension, there should be no problem.

Fang Lin's surgery was still not bad; as the Inpatient Chief of 912, his level is a bit higher than that of the director of Haicheng Shi Yiyuan.

"Let's check for pulmonary bullae, mediastinum, and pericardium." Zheng Ren said in a low voice.

"The pulmonary bulla in the lower lobe of the right lung had already closed during the second thoracotomy." Su Yun said.

"Let's check and see; otherwise we can't explain the pneumopericardium." Zheng Ren said.

Su Yun touched the pericardium with the hemostatic forceps, hesitated a moment, and said: "The pericardial pressure is greater than before."

Saying that, he didn't hesitate, picked up the knife, and directly incised the pericardium.

If this happened off the table or during transport, the patient would face extreme danger. But on the operating table, a simple pericardial incision for decompression is nothing.

Fang Lin also didn't say much more to Zheng Ren, began a pericardial window procedure, sent the excised pericardium for pathology, and used a syringe to draw some pericardial fluid for related tests.

The pericardial fluid volume was about 700 ml, clear, ruling out bloody pericardial effusion.

Under normal circumstances, we should now irrigate the pleural cavity; the surgery should be ending.

However, while irrigating the pleural cavity, we indeed found a small amount of gas leaking out.

Fang Lin and Su Yun searched on the table for a while, and finally found the problem in the mediastinum.

A small fistula had formed between the trachea and pericardium; strangely, this fistula also had a channel leading to the pleural cavity.

During transport, the patient had a small amount of pneumothorax, which can be explained by this. Because the patient was weak and had insufficient pulmonary ventilation, a large amount of gas-fluid pericardium did not occur.

However, under general anesthesia with mechanical ventilation, the patient's ventilation increased, and some gas entered the pericardial cavity, forming gas-fluid pericardium.

The condition isn't particularly special, at least as Zheng Ren sees it. But this patient… undergoing successive surgeries, it's like facing the elusive Death from "Death Comes".

Such a complex hernia ultimately led to gas-fluid pericardium; Zheng Ren said he had never seen this before.

Even in the vast sea of medical journals and papers, no related cases are mentioned.

But having found the problem is good; the subsequent surgery isn't difficult, just removing the fistula to eliminate the hidden danger.

"Boss Zheng, this patient's life is truly big." After repeatedly irrigating the pleural cavity with no issues found, preparing to close the chest, Fang Lin remarked.

"As long as it's fine, hurry up and close the chest." Su Yun used the approximator to clamp both sides of the ribs, began tightening the screws, and brought the approximator together.

Suturing is the most basic, but Su Yun seems not to have done thoracic surgery in a long time, and she didn't let this surgical opportunity pass. The trainee beside her looked helpless, but couldn't say anything.

Fortunately, 912 has a huge volume of surgeries; if one wants to do them, there's never a shortage.

Having come here, the biggest problem is that the body can't keep up. If every surgery were done, one could spend all time besides eating and sleeping on the operating table.

After eliminating the hidden danger, the atmosphere relaxed. There was chatting and laughing; the anesthesiologist told Su Yun and Fang Lin about the recent parturient.

Everyone agreed that something was likely to happen. Such an incident—one corpse, two lives—would bring major trouble for that obstetrician.

"When I was interning, I once encountered a family member telling the doctor, 'If it's a girl, go ahead and ligate the mother's right fallopian tube as well.'" Su Yun sneered.

"Uh… why?" Zheng Ren blinked.

Can one just say "close" and close a fallopian tube?

"Because men are left, women are right." Su Yun said: "Close the right fallopian tube, and next time we can have a boy."

"……" Zheng Ren was speechless.

Although one has been in clinical practice for many years, one still gets an absurd thought when encountering similar patients or cases.

……

……

Diaphragmatic hernia with air-fluid pericardium, a case report in the Xin Ying Ge Lan journal mentioned it; the patient was from Ageting.