Free Web NovelChapter 115: Chapter 114: Transformation
11:14 PM.
A torrential downpour!
Jiang He changed his clothes and entered the ER.
The ER was chaotic and noisy, but largely orderly.
Different colored fabric strips were tied to each victim’s wrist:
Black, red, yellow, and green.
Black tag: Deceased or with no indication for resuscitation.
Red tag: Critical, requiring immediate resuscitation.
Yellow tag: Seriously injured, but vital signs were temporarily stable.
Green tag: Minor injuries.
After the great earthquake in May of this year, the Ministry of Health had issued emergency guidelines for triaging casualties in major incidents.
Affiliated Hospital No. 1 was one of the first to implement this triage system.
Times were changing. Disaster had given rise to a more efficient emergency response system.
「The Red-Tag Zone.」
A man in his thirties lay on a gurney, covered in muddy water, his consciousness already fading.
Jiang He pressed both hands on the man’s abdomen.
His entire abdomen was tender, with rebound tenderness and muscular rigidity, especially pronounced in the upper left quadrant.
The man’s radial pulse was weak, and his limbs were cold and clammy.
Jiang He felt the man’s wrist as he issued orders:
"Severe hemorrhagic shock. Start two large-bore IV lines immediately. Give him a unit of Ringer’s lactate to start."
Xu Chen, who had just stepped away from a patient with a flail chest, stood a few meters away, completely at a loss.
He was stunned when he saw Jiang He.
And seeing Jiang He issue orders so calmly left him even more dumbfounded.
Nearby, an ER nurse saw the ID badge on Jiang He’s chest and recognized him.
’So this was the genius doctor everyone in the hospital had been buzzing about.’
But for a moment, she hesitated to follow his orders.
Jiang He’s hands had already moved to the man’s left hypochondriac region. He bent his middle finger and performed a quick percussion.
The area of dullness was enlarged.
He immediately said, "Possible splenic rupture. Go get the bedside ultrasound machine."
Hearing this, the nurse still didn’t move.
The ER had strict rules.
She didn’t dare listen to Jiang He.
"Do as he says!"
From Bed Two, just a few steps away, Zhao Yumin turned and spoke.
"He is Director Yang Xu’s student! He’s also a doctor I trust. Tonight, in this hall, his words carry the same weight as orders from the chief resident on duty. If anything goes wrong, I’ll take responsibility. Now go!"
The nurse was stunned for a second, but Zhao Yumin’s authority was unquestionable. She nodded immediately. "Right!"
Without another word, Zhao Yumin turned back and resumed chest compressions on the patient on his gurney.
He knew very well.
In a disaster like this, one more person who could handle the pressure could save countless lives.
’I saw too much helplessness back in May. Tonight’s story will not be a repeat of that.’
11:16 PM.
The ultrasound machine was wheeled over.
It was a 2008 model, so the imaging wasn’t particularly clear.
Jiang He gripped the probe with one hand, applied coupling gel, and quickly swept it over the man’s hepatorenal recess.
The black-and-white ultrasound image showed an anechoic area.
A large amount of free fluid was in the abdominal cavity.
Jiang He said, "Notify the OR. Emergency exploratory laparotomy. Prep four units of red blood cells and 400ml of plasma."
The nurse quickly replied, "The operating rooms are all full."
Jiang He frowned.
He immediately offered an alternative plan:
"Contact the blood bank and get the blood. Move him to the observation area for now. Keep up the fluid resuscitation, maintain his systolic pressure around 80. Permissive hypotension—don’t dislodge the clot. Monitor his vitals constantly. The moment an operating table frees up, he’s the first one to go."
"Understood!"
The nurse carried out the orders.
Jiang He turned, ignoring the pain in his ankle, and walked quickly to the next bed.
Xu Chen was still frozen in place, staring blankly at Jiang He’s retreating figure.
Jiang He’s leg was clearly injured; he walked with a limp.
But he showed no signs of panic or fear.
Only professionalism.
Xu Chen was speechless for a long time.
He only snapped out of it when a nurse called his name.
"Coming!"
11:28 PM.
In a corner at the back of the resuscitation room, a short-haired woman lay on a gurney.
She had no obvious external bleeding, but she was gasping for air, her lips visibly cyanotic.
As Jiang He walked over, the woman was looking at him, her hands gripping the sheets tightly, her eyes filled with terror and despair.
"Doctor, I... can’t breathe... My chest... it feels tight..." the woman said haltingly, large beads of sweat covering her forehead.
Jiang He immediately grasped her wrist, feeling for her pulse.
Her pulse weakened significantly, almost disappearing, with each inhalation...
Then he pressed his ear directly against the woman’s chest wall.
The heart sounds were distant and faint.
Elevated venous pressure, decreased arterial pressure, and distant heart sounds.
Beck’s triad.
"Cardiac tamponade," Jiang He said, turning to the nurse. "What was her last blood pressure reading?"
"The non-invasive cuff couldn’t get a reading. I used a mercury sphygmomanometer just now and got about 70 over 40."
"Get a pericardiocentesis kit. Prep lidocaine and atropine. Quickly."
The woman’s breathing grew more labored. The restriction on her lung expansion made her feel like she was suffocating.
Tears streamed from the corners of her eyes as she stared intently at Jiang He. "Doctor... am I... going to die? My son is only five. I don’t want to die, I want to watch him grow up..."
Jiang He looked down into her eyes.
His expression was calm.
In the frantic ER, that calmness carried a reassuring power.
Jiang He said, "Don’t be afraid. I’m here."
Hearing this, the woman’s tears continued to fall, but her trembling subsided slightly.
The nurse ran over with a cart and tore open a sterile pack.
Jiang He put on sterile gloves, took a povidone-iodine swab, and quickly disinfected a wide area just below and to the left of the woman’s xiphoid process.
"Drape."
"Local infiltration anesthesia."
Jiang He took the syringe, drew up the lidocaine, and inserted the needle at the angle between the xiphoid process and the left costal arch.
In 2008, a puncture like this relied heavily on a doctor’s anatomical knowledge and feel.
