Chapter 71
Suction!
The sound of blood and vomit being sucked from the patient's mouth tore through the resuscitation room.
At the same time, Han Jae-eon shoved in the laryngoscope without the slightest hesitation and inserted the tube.
Airway secured, airway.
The alpha and omega of trauma patient care.
First, get them breathing. Only then is there a next step.
My role is Circulation.
Circulation.
Along with Lee Min-jae, my job was to somehow stop the blood leaking from the patient's body and replace it with the same amount.
I climbed onto the patient's limp body.
The horrific wound exposed beneath the torn pants. Bone fragments jutting through skin and muscle, with blood gushing around them.
Open pelvic fracture.
“Pelvic binder's on!”
I cinched the patient's pelvis tight with the giant belt, the pelvic binder.
A desperate struggle to stabilize the shattered pelvic bones and cut internal bleeding even a little.
But the amount of blood seeping out under the binder showed no sign of slowing.
Everything was at its worst.
Every goddamn shitty situation I'd been drilled on over the past year screamed through my head.
Massive hemorrhage, shock, metabolic acidosis, hypothermia, coagulopathy.
Forget the lethal triad and all that crap—what was in front of me now was just a person about to die.
“We already gave two liters, so why the hell is the blood pressure still the same!!”
Lee Min-jae shouted, almost in tears.
Lee Min-jae's hands looked like they were ready to burst the pressure bag.
The two clear fluid bags hanging from the IV pole were already shriveled.
Clear, transparent fluid was pouring madly into the patient's body through the thick line, but it was like pouring water into a bottomless pit.
The rate at which blood was bursting out somewhere was faster than the rate it was going in.
But the blinking numbers on the monitor were mocking our prayers.
Please go up already, you goddamn blood pressure bastard.
I pressed on the patient's abdomen, cursing the numbers on the monitor in front of me. Those red digits were mocking every effort I made.
[BP: 65 / 35]
Bullshit.
I spat the curse inwardly.
Two liters? Even twenty wouldn't make it come up.
Even as we poured in fluids, it was dropping instead of rising.
That meant there was no more blood left flowing in the vessels.
The patient's body was just a bottomless pit now.
At the same time, fluid was pouring into the line in one hand while blood gushed out like a fountain from below the shattered pelvis.
[HR: 145]
The heart rate was blinking like crazy.
Yeah, that heart bastard was the only thing working its ass off right now.
With no blood in the body, it was desperately pumping empty, trying to squeeze out the last drop and send it to the brain and heart.
But that wouldn't last much longer either.
At this rate it'll just wear itself out and go V-fib
(* ventricular fibrillation)
or Asystole
(* asystole)
in no time.
[SpO2: 92%]
Even with a 15-liter mask practically jammed over the patient's nose and mouth, it was still dropping.
That meant there wasn't any blood left to carry oxygen.
What good is a green light when there aren't any cars on the road?
There's no car to make the delivery.
“Doc! He's gonna arrest before we even get on the elevator. When's trauma surgery coming!”
Bae Eun-seo's voice was trembling.
To that innocent first-year, this situation probably looked like the end of the world.
That wasn't wrong.
At least for that patient, it really was the end.
Lee Min-jae shouted at Park Seong-jeong, who had frozen in front of the whiteboard.
Park Seong-jeong's face was already chalk white, with not even a trace of color left.
Yeah, that's the normal reaction for a first-year.
And the crazy one was me, charging into that hell and trying to do something.
“One line's blocked! It's backflowing!”
Damn. I heard the nurse's shout.
Did the line that had been backflowing earlier clog up again?
With the blood pressure that low, one of the lines we'd barely managed to place had died.
“Bring the IO needle! I'll drill through the damn bone if I have to and get it in!”
Lee Min-jae looked like he was almost half out of his mind now.
Intraosseous access (IO).
That means drilling a hole in the shinbone with a drill and forcing fluids in.
That's the real last resort.
But right now, all we had left was that last resort.
Even then, fourth-year Han Jae-eon was silently squeezing the Ambu bag at the patient's head, securing the airway. What on earth was that senior's mental fortitude made of?
“Han Hyeon-jae! Press properly! Don't let go!”
At Lee Min-jae's bark, I came to my senses.
The feeling beneath my palm was horrific. The abdominal wall that should've been solid was nowhere to be found, and all that came through was the disgusting, helpless feeling of pressing down on a squishy blood bag.
Was there even any point to throwing my weight into this? Wasn't this just like trying to stop a burst dam with bare hands?
“Blood's here!”
It was a voice like salvation. In the intern's hands, who had run over from the blood bank, were two O-type blood packs.
“Oh, hook it up right away! Hurry!”
Lee Min-jae shouted. The nurse cut the fluid line and connected the blood pack. As the pressure bag was squeezed, dark red blood flowed through the tube into the patient's body.
I was still pressing down on the patient's abdomen like a man possessed.
Ugh, the feel of this is the absolute worst.
‘...Fuck.’
Is this really the end? Am I just going to watch a person slowly go cold under my hands like this? Was all this effort, all this struggling, nothing more than a show that delays death's predetermined ending by a few minutes?
A sense of helplessness washed over my whole body. That shitty feeling I'd experienced countless times since entering this hellish ER, but one I could never get used to.
Everything in front of me seemed to move in slow motion.
The monitor's wailing, the seniors' near-agonized shouts, the faint warmth of life fading beneath my palm.
Ah, damn it. Should I open the gallery?
Memories from my first-year days suddenly came back.
Possession.
And the God of the Scalpel.
Use possession again?
I shook my head.
No.
Things were different now.
At this point, opening up the abdomen didn't seem like it would do any good....
And cutting open the abdomen wouldn't solve anything either....
Back then only the abdomen was the problem, but now the pelvic bones were a problem too.
Now there were double the problems.
Wouldn't I just end up wasting even more time?
Instead, my own body would be the one to endure 12 hours of hell.
The patient would die, and I'd end up half crippled too.
This wasn't a rational choice.
Dammit, I don't know.
I forced myself to shake off that temptation.
For now, let's focus on the most basic thing I can do.
“Doctor!”
I shouted at Lee Min-jae, who was almost out of his mind squeezing the bag.
“I'll squeeze the blood bag! Doctor, please take one more look with the ultrasound!”
“Oh, yeah! Thanks!”
Lee Min-jae handed me the pressure bag and grabbed the ultrasound probe again.
“Eun-seo!”
I grabbed Baek Eun-seo by the shoulder, where she stood beside me, at a loss.
“You! That! Keep the pelvic binder tight on both sides! If he bleeds any more from the pelvis, it's really over!”
“Yes!”
Baek Eun-seo hurriedly started holding the binder in place.
Lee Min-jae's face was slick with sweat.
“FAST! Let's see FAST! Where the hell is it leaking from!”
Soon, Lee Min-jae's face twisted.
“Damn... the spleen. The spleen...”
I squeezed the pressure bag holding the blood pack like a madman.
Cold blood flowed through the tube into the patient's body.
Yeah, right now I'm just squeezing the bag....
Let's try asking for help.
A moment ago there had been plenty for me to do, but now all I had to do was squeeze the bag. If there was ever a time to ask a question, it was now.
I hurriedly opened the blue window floating in midair and started typing.
[Dead Medical Scholars Gallery]
Title : HelpHelpFuckThisIsUrgentAsHell
Author : Hell Joseon Slave 1
20s/M, TA, open pelvic Fx c massive hemoperitoneum. BP 60s, HR 140s. MTP underway but no response. Waiting for trauma team, ETA 10+ min.
[Comments]
ㅇㅇ (210.94) : Wow... that's pretty bad. At that point he's basically half a corpse, isn't he?
Operating Room Ghost 3 : How about it, internal med bastards? This is the real battlefield. It's on a whole different level from you guys just clicking through charts all day.
ㄴ Back in My Day : Instead of posting this bullshit, think about how to save that patient, you psycho bastard.
The gallery was spewing out useless comments.
What did it mean that even the gallery, which always gave the clearest answers, was filled with meaningless comments?
Would those crazy wraiths, who were dead serious about saving lives, really leave comments like that when there was already a solution?
No way.
It meant this was an extremely desperate situation.
Right then.
Han Jae-eon, who was squeezing the Ambu bag at the patient's head, spoke up.
“Doctor.”
“What! What is it!”
Lee Min-jae answered, snapping his head up.
“EtCO2 (* end-tidal carbon dioxide), it's 20. The heart's going to stop soon. We don't have time.”
Normal is 35 to 45.
An EtCO2 of 20 meant the heart was pumping so little blood that there wasn't even enough left to carry carbon dioxide to the lungs.
One of the strongest warning signs of cardiac arrest.
And that warning became reality immediately.
“BP 55 over 30! Still dropping!”
The nurse's scream burst out.
At the same time, the heart rate on the monitor was shooting up like mad, as if making one last desperate struggle.
155 bpm.
160 bpm.
165 bpm...
“Shit, fuck! This is insane! No! Don't, you bastard of a heart! Hang on!”
Lee Min-jae screamed at the monitor.
In the midst of it all, I saw one freshly refreshed comment in the gallery window in my head.
God of the Scalpel : Try possession. Yeah. I'll handle it.
…
……?
I couldn't believe my eyes.
Solve it?
This?
ㄴ Hell Joseon Slave 1 : There's a way to solve it? How?