Free Web NovelChapter 1109: Chapter 1109: Potassium Supplementation Requires Caution
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"One milligram of epinephrine, Liu Yiqing do CPR, charge to 200 J and stand by, I’ll intubate."
Liu Banxia directly issued the resuscitation orders.
He’d really been afraid of this exact thing, afraid the patient would go into ventricular fibrillation, and now it had actually happened. The patient hadn’t been transferred to the ICU yet, jurisdiction was still in his hands, so he had to take the lead.
Everyone moved at once. For the people in the emergency center, this was all familiar work.
It was just that no one had expected this patient to deteriorate so fast.
"Director Liu, charging complete."
As soon as Liu Banxia finished the intubation, the nurse beside him reminded him.
"Clear."
"Snap."
"Continue compressions, 200 J."
The first defibrillation didn’t restore sinus rhythm the way everyone was hoping. Liu Yiqing started CPR again.
"Charging complete."
"Clear."
"Snap."
"Sinus rhythm restored, we got him back."
Seeing the numbers on the monitor, the nurse next to them shouted.
"Hurry and place a central venous line to infuse potassium chloride. Dr. Zhang, what’s the regimen?" Liu Banxia looked over at Zhang Zhiyuan.
"1.5 grams per hour, 6% concentration. He’s already developed respiratory muscle paralysis and arrhythmias; we need to bring it up quickly, otherwise we’ll be resuscitating him all over again," Zhang Zhiyuan said.
"Once you start the potassium, send him to our ICU. We can monitor more closely. Otherwise it’s hard for you to manage him here, it’s actually less convenient than on our side."
Liu Banxia nodded. "We’ll do it that way."
Ding! Task ’Emergency Rescue of Myasthenia Patient’ completed
Gained 200 experience points, Glory Points +5
This task was rated Perfect. Gained 300 experience points, Glory Points 10 + 5, Solidification Stone ×1
Such a simple task with such generous rewards was enough to prove just how dangerous the patient’s condition really was.
Potassium supplementation is a very critical maneuver. It’s not only crucial for patients with hypokalemia; it’s also extremely important for the medical staff. There are strict regulations on both the concentration and speed of intravenous potassium supplementation.
Liu Banxia was still the deputy director of the emergency center, yet even he didn’t dare make arbitrary decisions about rapid potassium dosing. He could only rely on the judgment of an experienced physician like Zhang Zhiyuan.
If you just think "low potassium, so let’s just give potassium" and push it straight in as a bolus, that’s it—the patient will be gone on the spot.
That’s not saving people; that’s harming them.
If you really give a bolus push, it will cause a transient spike of extracellular potassium concentration, and the body’s functional systems can’t adjust that fast.
That’s also why they were all worried the patient might go into ventricular fibrillation again—because the absorption and re‑equilibration of those potassium ions takes time.
Right now they were giving the patient potassium through a central venous line. The advantage is that you can use a higher concentration and a faster rate.
If you use an ordinary peripheral vein, the irritation to the vessel wall not only hurts, but can also trigger phlebitis and other problems.
If you really have no choice but to use peripheral veins, the potassium concentration should be kept at 3% or less.
Zhang Zhiyuan’s order was 6% concentration, 1.5 grams per hour. That was already a very high concentration and rate of potassium supplementation, and that was because the patient’s hypokalemia was currently too severe.
Once he got to the ICU they would need to monitor him constantly and then adjust the medication and rate accordingly.
"My god, Teacher Liu, I was just scared out of my wits," Liu Yiqing said, wiping the sweat from her forehead after the patient was wheeled to the ICU.
"Same for all of us. It’s the patient’s luck, and it’s our luck too. At least now there’s still a chance to save him. Otherwise, we wouldn’t even have the tiniest sliver of a chance," Liu Banxia said with a sigh.
"Good thing we had all the equipment prepared in advance. Otherwise we’d have wasted more time and the resuscitation would have been even harder," Liu Yiqing said.
The people around them all nodded in unison. In fact, with every emergency rescue, you’re also watching to see whether fate is on your side.
When a patient goes into ventricular fibrillation, it honestly isn’t guaranteed that defibrillation will work. All you can say is that your resuscitation efforts give the patient one more chance to keep living—and chances are never one hundred percent.
"Teacher Liu, why is it that this patient’s serum potassium is so low, but he himself felt totally fine? Yet after being here for such a short time, he went into ventricular fibrillation?" Liu Yiqing asked again.
"It might have something to do with his psychological changes," Liu Banxia thought for a moment and said.
"Even though we tried our best during the initial admission to make him feel no threat to his life, he himself would definitely be thinking about it."
"With that kind of worry, his emotions could fluctuate quite a bit, which would speed up his endocrine system. It might be precisely because of that that his body changed and he went into VF."
"Endocrinology is a pretty peculiar system to begin with. Like last time with Tang—who would’ve thought a thyroid problem could be related to bed-wetting?"
"That’s why people keep saying medicine is truly a field where learning never ends. The human body is so mysterious; you can only grasp the patient’s condition at that moment and try to monitor as much as possible, but you can’t truly have real-time control."
"When the patient’s body is functioning normally, all kinds of trace elements’ levels are changing significantly every second. Otherwise all our indices and indicators wouldn’t be given as a range."
"I learned a new trick today myself. Next time I see a similar patient, as long as their general condition and indices are similar, I’ll feel confident following today’s workflow."
"Every patient we go through is part of our learning process. Here I also want to give a thumbs-up and commend all the staff who just took part in the resuscitation and management."
"This emergency rescue was actually different from our usual ones. The patient’s hypokalemia was too severe. Defibrillating and restoring sinus rhythm was only the first step."
"The most important part was the central venous catheter and the infusion pump settings, because the solution we just prepared, while it’s a life-saving drug, is also a deadly poison—something that could literally be used in an execution."
"But our medical and nursing staff were still able to stay orderly and composed at such a tense moment. Every single step was strictly in line with protocol, yet they didn’t waste time on the tedious checking procedures."
"Potassium supplementation itself takes a long time before the potassium level can be brought up. If we can fight for even one more second for him, that’s one more second of hope for life."
"I might not be able to take you all ’up to the sky’ like you saw yesterday, but having so many people with solid professional quality working with me really makes me happy."
"Thank you, Director Liu."
The nurses who had just taken part in the resuscitation thanked him sweetly.
Nursing work is actually really tough; both the duties within their job description and the extra things beyond it all have to be done.
They had just been following standard procedures, and hadn’t expected to be noticed by Liu Banxia, let alone praised. This truly surprised them, because compliments for nurses are actually not that common.
A lot of doctors habitually treat nurses like people they can order around at will. Even though they’re two completely different systems, that’s the unspoken rule.
It’s not about whether you’re willing or whether you understand; working in an environment like this, you just have to adapt.
But Deputy Director Liu is different. His attitude toward everyone is the same. Whenever something comes up, he doesn’t just think about the doctors, but the entire medical–nursing team.
Anyway, they just felt really happy—not only because Liu Banxia often treats them to food and drinks, but because they’re getting the respect they deserve, being treated as true colleagues.
"Teacher Liu, for this patient’s situation, is it enough just to supplement potassium?" Liu Yiqing asked.
"How could it be that simple? We still have to adjust the balance of the other electrolytes. And we have to watch his urine output, then modify the concentration and speed of the potassium chloride accordingly. It’s a very tedious job," Liu Banxia said.
"But for people in the ICU, this is routine work. That’s why we say they’re our last line of defense. Whatever we can’t hold, they have to carry."
"No matter how good we are on the operating table, that’s only one part of the whole process. For many critical patients, the time they spend in the ICU after surgery is also extremely crucial."
"That’s also why I sent you all to the ICU to train back then. After that rotation, your skills really improved a lot—not just in emergency handling, but also in your attitude toward admissions."
"Just now, although you were anxious, you didn’t panic. You were only anxious for the patient’s life, and that deserves recognition too."
Liu Yiqing nodded with obvious delight; she also liked hearing praise, especially since stingy Liu Banxia was really tight-fisted when it came to compliments.
"Not bad. What do you estimate the chances of successful resuscitation are?" Wang Chao came over too.
"Hard to say. The next few hours are the key," Liu Banxia said.
"If he really pulls through this time, he’ll probably take his hyperthyroidism seriously from now on and stop being so half-hearted."
"And it has to be said, pump infusion really is a magic weapon. The manipulation is a bit complex and strict, but at critical moments it’s truly powerful."
Wang Chao looked at him helplessly. "I’ve figured it out: ever since you had your two babies, you’ve been getting more sentimental by the day."
"Tsk, that’s called growth. What would an unmarried little brat like you know?"
After taking a jab at Wang Chao, Liu Banxia walked back toward the office with his hands behind his back, strolling along.
"What’s there to show off about? I’ll have three in the future," Wang Chao muttered unwillingly.
The people around them were cracking up. When Director Liu and President Wang get together, it’s actually pretty entertaining.
This bit of lively banter made a lot of interns and residents who’d come over to be assessed on debridement and suturing stare in curiosity.
They just felt that the atmosphere in the emergency center seemed a bit special, not quite like what they’d previously imagined. Supposedly it’s all because of Deputy Director Liu—not only is he highly skilled, he’s also very good at stirring things up.
