Chapter 174
…Yes, we'll admit him. Send him over.
Park Se-young made the decision in an instant.
“Hyeonjae.”
“Yes, Professor.”
I, too, sprang to my feet reflexively and put on my gloves.
“This is the 119 ambulance briefing from just now. At the scene, a steel plate pinned two workers. One seems to have taken a hard blow to the abdomen, and one has only a minor abrasion from falling.”
Park Se-young bit her lip and turned the page of her notes.
“Right now, the scene BP is 110 over 70, pulse 110. They say he's still mentally clear, but….”
“Hmm.”
I frowned the moment I heard those numbers.
Blood pressure, 110/70.
On paper, the numbers look normal, but the pulse is 110.
Considering a resting pulse is 60 to 80, that means a sturdy field worker is showing tachycardia.
“Compensated shock is likely. Young people can keep their blood pressure up by constricting their vessels even after losing 1.5 liters of blood. He could crash in an instant.”
“Right. And if it was a blow to the abdomen, we have to suspect organ rupture or internal bleeding. But the transport distance….”
“The transport distance is the problem, I guess.”
“Yeah. Even if they floor it, it'll still take quite a while….”
Park Se-young gave quick orders.
“First call trauma surgery, and call Anesthesiology to have them prep an OR. Tell them we may need to open him up right away.”
“Ah, uh… Professor.”
I was about to pick up the receiver when I froze.
“Why? Is something wrong?”
“Because today is the weekend….”
I glanced sideways at the whiteboard with the on-call roster.
“Ah.”
A look of dismay flashed across Park Se-young's face.
The weekend.
The university hospital's weakest time.
If it were a weekday, no, at least if this were the main hospital, the trauma surgery professors would be on-site and on standby, but not here today.
“Who's on call for the severe trauma team today? Surely it's not empty, is it?”
“It isn't empty, but….”
I checked the on-call roster.
“It's Dr. Jeong Moojin from GI Surgery.”
“Ugh….”
Park Se-young let out a pained groan.
Of course, he's an excellent surgeon, but trauma surgery isn't his field.
If we open him up and find the aorta ruptured or the liver mashed to pulp, it could be hard to handle.
But right now, we need someone with a scalpel in hand.
“Call him first. We need someone who can pick up a scalpel.”
“Yes, understood.”
I immediately picked up my phone.
Brrring-
[Yes, this is the severe trauma team on-call room.]
“Yes, doctor, thanks for your hard work. This is the ER. You're the on-call doctor for the severe trauma team, right?”
[The ER? Is a trauma patient coming in?]
“A patient suspected of intra-abdominal bleeding from blunt abdominal trauma is due to arrive in 15 minutes. Scene vitals are unstable, and there are signs of shock. We need you down here right away.”
[….Shit. Of all days. Yes, yes. I'll be there within 10 minutes.]
“Yes, please.”
When I hung up and turned around, Park Se-young was already making a call to somewhere.
“...Dr. Jeong Moojin says he'll be down within 10 minutes. But who are you calling?”
“The chief.”
Park Gwang-seok, the center director?
Why him?
“Why the chief?”
“Still, I thought it would be better than having nothing. They said there's another patient coming in—not serious, but borderline. We might be short-handed. If you and I are tied up with the critical patient, who's going to see the others? We need bodies, at least.”
It's not a mass-casualty incident, but if two patients come in at once, the understaffed ER could still get overwhelmed.
If even Park Gwang-seok comes to cover the other patients, it wouldn't be bad.
“He's probably in the auditorium. He went to the vision declaration ceremony because the director was coming.”
“But even so, people usually don't turn off their phones. He should be able to take a call.”
Brrring-
Brrring-
Only the ringing went on and on; the call never connected.
“Haa….”
Park Se-young stared down at the phone, crestfallen.
“I called, but he won't pick up. Should I just hang up? What the hell is the chief doing right now?”
“Professor.”
I pulled the portable ultrasound unit beside the bed over and spoke.
“Just now you told me to add a respectful suffix after 'chief,' but you're not even pretending to be respectful yourself. 'What is the chief doing right now?'”
Park Se-young glared at my remark.
“I'm the professor.”
“Yes, Professor.”
Our brief joke eased the tension.
We moved in perfect sync.
We hung the IV, prepared the intubation tube, and turned on the ultrasound machine.
That was when it happened.
Brrrrring-
The phone rang again.
A nurse snatched up the phone and shouted a moment later.
“Professor! 119 is calling again!”
“Why! Has he gone into arrest?”
Park Se-young asked.
“No! He hasn't arrested yet, but his vitals are crashing! They say BP is 90 over 70, and his pulse has shot up to 130!”
“This is insane.”
The pulse pressure had narrowed to 20.
It was a sign that the heart was trying desperately to squeeze out blood but had nothing to work with.
“And it might not be related, but to the naked eye they can see jugular venous distension in the neck!”
“What? Jugular venous distension?”
Park Se-young and I met each other's eyes at the same time.
Was the chest injured too?
I was sure I'd heard in the statement that he was hit in the abdomen.
Then what could have injured the chest?
'In cases like this, it's usually a tension pneumothorax or cardiac tamponade….'
Whatever it was, it meant multiple trauma.
We either misread the situation at the start, or the EMT just saw something wrong.
The latter is unlikely, so I’m betting on the former.
“The compensatory mechanism is nearly spent. He's at the edge of the cliff.”
Park Se-young bit her lip.
“What are the sats?”
“They're around 90! Even with a mask on! They'll be here in six minutes!”
Six minutes.
“Hyeonjae.”
“Yes.”
“Ready?”
“Yes, I'm ready.”
I turned my head and looked toward the outside.
“First, since there's jugular venous distension, call CS right away too! Tell them there's a possibility of tension pneumothorax or cardiac tamponade, so we may need a chest tube or pericardiocentesis!”
At my shout, the nurse picked up the receiver and dialed.
“Yes, doctor! I'll call them right away!”
Beside the resuscitation bed, I checked the Ambu bag and intubation tube while running the scenario through my head.
'Tamponade(* cardiac tamponade)? Pneumothorax(* collapsed lung)?'
A bulging vein in the neck means blood can't get back into the heart.
Either the chest is full of air from a pneumothorax, or blood has pooled in the membrane around the heart and is squeezing it in tamponade.
Either way, if it isn't treated immediately, he'll go down all the same.
After finishing the trauma resus setup in that brief moment, I habitually opened the gallery window in midair.
For a severe trauma case, it's better to get confirmation from the veterans before starting treatment on scene, just in case my judgment is right.
…
***
God of Scalpels: Enough!!! Ask away!!!
ㄴ Hell Joseon Slave 1: No, it's urgent.
ㄴ God of Scalpels: You're right about everything!!!!!!! That's exactly how you do it, and that's exactly how you read the ultrasound!!!!!! You've already decided all this in your head! Then why the hell do you keep asking!
ㄴ Hell Joseon Slave 1: But in cases like this, when hypovolemia is also present, JVD may not show up clearly. But it's so obvious that maybe there's another cause
ㄴ God of Scalpels: You studied hard!!!!! That's right!!!! Your judgment is right!!!!
ㄴ God of Scalpels: If it really looks like you're totally screwed, then use possession then!!!!!! Why the hell are you so damn tentative, you little bastard!
ㄴ Thoracic Surgery Veteran: Hell-slave, that's enough ㅇㅇ. Go by the differential diagnosis order you're thinking of. Just do it.
'...Thank you.'
I had been chewed out, but for some reason I felt reassured.
Right, my judgment wasn't wrong.
After roughly getting the confirmation I needed, I swiped the gallery screen away.
Then Professor Park Se-young shouted to the nurse outside.
“When is thoracic surgery coming? Did they take the call?”
“Thoracic surgery isn't answering the phone right now!”
The nurse, looking teary-eyed, took the receiver away from her ear.
“They're not picking up on their personal phones, and the on-call room is dead silent too.”
“Ha, I'm going crazy. Then call the ward nurse station! Or make an announcement or do whatever it takes to find them!”
“Ah… y-yes! Understood!”
I don't know whether the thoracic surgery doctor went to the bathroom or went to eat, but being absent right now is fatal.
Then the automatic doors opened, and a sweat-soaked man ran in.
A GI surgery fellow and general surgery specialist.
It was Dr. Jeong Moojin, the severe trauma team's on-call doctor.
“I'm the trauma team on call! Sorry I'm late!”
“Ah, you're here!”
Perfect timing.
At the same time, a loud siren sounded from the ER entrance, and soon the EMTs' urgent shouts followed.
“Patient coming through! Move!”
Rattle-rattle-rattle.
A stretcher rolled in, carrying a man in blood-soaked work clothes.
His face was beyond pale, almost ashen, and even with an oxygen mask on, he was gasping.
“BP is 80 over 60! It dropped hard! Pulse is 150, and even with 15 liters of oxygen, his saturation is barely hanging on at 90%!”
The EMT shouted, drenched in sweat.
“Okay, we'll move him! One, two, three!”
Heave-ho!
The patient's body was moved onto the resuscitation bed.
“We got both lines in and ran fluids wide open, but the BP isn't coming up well! There also seems to be a sign of abdominal distension!”
“Yes! Thank you! Great work!”
As soon as the EMTs stepped back, the medical staff swarmed the patient.
The nurses pulled out scissors and ripped the patient's clothes to pieces.
“Patient coming through!”
Right behind that, a second stretcher came in.
It was the mild, or perhaps moderate, patient I had mentioned earlier.
A patient who wasn't seriously injured.
“I'll go over there! Dr. Jeong Moojin, Hyeonjae, take a look at this one!”
Park Se-young called out briefly and moved to the patient on the side.
Since a surgeon had arrived, she judged it better to take the other patient herself and coordinate the overall flow.
Reasonable.
“Doctor! I'll secure the airway and place a C-line(* central line)! You handle the FAST(* ultrasound)!”
I shouted and moved to the patient's head, lifting his chin.
He was lethargic.
Probably because of the pain, he only let out groans, and a proper conversation seemed impossible.
'RSI meds are…'
“Gel! Give me gel!”
Jeong Moojin snatched the ultrasound probe.
With practiced hands, he squeezed out the gel and set the probe in place.
A black-and-white image appeared on the ultrasound screen.
If there were intra-abdominal bleeding on the ultrasound screen Jeong Moojin was looking at, a black fluid shadow should appear between the liver and kidney or around the spleen.
'He said he took a steel plate to the abdomen, right? Then there'd probably be blood everywhere from a ruptured spleen or ruptured liver. This is going to be rough for surgery...'
But then.
“…Huh?”
Jeong Moojin's hand stopped short.
He twisted the probe this way and that to check again.
Right upper abdomen, left upper abdomen, pelvic cavity.
“Hmm?”
Jeong Moojin's expression twisted strangely.
He lifted his head and looked at me, who was preparing to intubate.
“Um… ER doctor? Dr. Han?”
“Yes? Is there a lot of blood? Should we send him to the OR right away?”
I asked, holding the laryngoscope.
Jeong Moojin said in a trembling voice.
“The abdomen is fine? I don't see a single drop of blood...”
“…What?”
He took a hit to the abdomen, but the abdomen is fine.
But the patient is in shock.
The blood pressure is 80, and the pulse is 150.
Then where is the blood coming from?
No, if blood isn't leaking, then why did he go into shock?
In that instant, the jugular venous distension the EMT had mentioned earlier flashed through my mind.
And the moment Jeong Moojin moved the probe toward the pit of the stomach, toward the heart.
On the ultrasound screen, a tiny heart crushed so it couldn't even beat came into view.
And the huge blackness filling the area around it.
“…The heart.”