This is not the Dr. Li he knew, who had been at Guandu Health Center for ten years. That Dr. Li was gentle, calm, ticulous, taking twenty minutes to ask about patients and never prescribing more than three dications. That Dr. Li never spoke with such a tone, as if commanding a battle like a General.
Yet this was clearly Dr. Li. Still the slightly sun-tanned face, still the hands with distinct joints due to long-term use of surgical knives. Only those hands now firmly held a string of lives dangling on the edge of a cliff, without a hint of tremor.
He suddenly realized that from entering the Hospital until now, Li Min hasn’t shown any panic; he operated like a precision instrunt already programd beforehand, running at full speed the mont the wounded arrived, without any hesitation, without a single redundant action.
This year, what did he go through in the Provincial City?
The sixth injured person carried off the car was Xu Dehou, a man in his fifties, the driver, whose arrival caused a brief second of silence in the entire ergency hall.
It was a body with almost invisible injuries, yet the face was pale as paper, the thorax rising and falling in a bizarre manner, not the even expansion and contraction of normal breathing, but with every inhalation the right chest wall collapsed abnormally.
"Flail chest!" Li Min’s first reaction, he squatted down, gently pressing his hand on the collapsed chest wall. "Multiple fractures of multiple ribs, abnormal breathing. Pulmonary contusion, high possibility of tension pneumothorax."
His hands didn’t stop, already accepting the stethoscope handed over by the nurse.
"Right breath sounds disappeared, trachea deviated to the left." He put down the stethoscope. "Tension pneumothorax, imdiate decompression, then closed thoracic drainage."
The nurse was sowhat at a loss beside him.
"Give a thick needle! Then imdiately prepare a thoracic closed drainage kit."
The new Hospital has these kits prepared.
The nurse imdiately handed over the thick needle, Li Min’s fingers searched within a few rib spaces for a second, the needle angled and pierced in.
A stream of air mixed with fine blood froth sprayed out from the tail of the needle. The man’s breathing cald down almost instantly, his pale lips gained a faint blood color.
"Tension pneumothorax relieved!" Li Min stood up. "But the chest trauma is severe, cannot rule out heart or major vascular injury. Thoracic closed drainage kit to ! I’ll perform the closed thoracic drainage imdiately, prepare the ventilator, notify the Operating Room, monitor this one while preparing for surgery, ready for thoracotomy exploration at any ti."
Ventilator? No one knew how to operate the ventilator.
Although the new Hospital is well-equipped, personnel training hasn’t caught up, the first batch sent for training hasn’t returned.
Li Min saw everyone’s expressions and knew what was going on: "Don’t worry, just be prepared, I’ll operate."
With his reassurance, everyone was relieved.
He spoke this sentence with a normal tone, anwhile already completing the closed thoracic drainage, the speed of judgnt and decisiveness of action were breathtaking.
The Elderly Director stood two ters away, shocked. When he heard Li Min talking about thoracotomy, he imdiately ca forward: "Xiao Li, you’re going to perform a thoracotomy? We should only handle what we can, send severely injured ones to the county!"
To the county?
Li Min hesitated for a second, then quickly said, "No ti to send, I’ll do the surgery!"
"Xiao Li..."
This is thoracotomy, it’s thoracotomy! The county can’t handle it, needs to be sent to a prefecture-level hospital, so might need to be sent to the province.
When Li Min was at Sanbo for training, Yang Ping set his targets in surgical operation as "proficient in so, knowledgeable in so, exposed to so." "Proficient in so" included almost all life-saving ergency procedures that might be encountered at town hospitals.
These were no big deal for him.
Li Min had no ti to explain to the Elderly Director.
Unexpectedly, even more severely injured were coming.
The seventh injured person was the last one carried out of the vehicle. Zhou Daping personally supported his head, his voice completely altered:
"Dr. Li, this is Zhou Fusheng, Zhou Fusheng! He was still driving just now, when the car overturned the steering wheel pressed against his chest, he fainted imdiately, hasn’t woken up since..."
Li Min squatted down.
A man in his fifties, face ashen gray, lips cyanotic, carotid pulse weak as a dwindling candle fla. In the midsection of his sternum, there was a palm-sized area of subcutaneous bruising in the shape of a steering wheel.
"Pre-traumatic cardiac arrest state." Li Min’s fingers were on his carotid artery. "Suspect cardiac tamponade, bedside ultrasound."
A portable ultrasound was pushed over, the doctor doing the ultrasound was a bit flustered, how could she handle such a scene, Li Min reassured her: "Let do it!"
Li Min took the probe, sared coupling agent on the chest wall, the probe descended.
On the screen, the outline of the heart was tightly encircled by a dark area of fluid, like a bird clutched in a fist.
"Massive pericardial effusion, the right ventricle compressed and collapsed." Li Min’s voice remained calm. "Pericardiocentesis drainage, imdiately!"
The nurse brought over the pericardiocentesis kit, Li Min put on sterile gloves, disinfected, laid towels, the puncture needle pierced in from the angle between the xiphoid process and the left rib arch, the needle tip advanced slowly.
Everyone held their breath.
Dark red blood slowly flowed out from the tail of the needle, like unscrewing a hidden valve. On the electrocardiogram monitoring, the previously almost flat line began to show weak, fragnted fluctuations.
Zhou Fusheng’s eyelashes trembled slightly.
"Hemorrhagic pericardial effusion, indicating myocardial or coronary artery injury." Li Min stared at the monitor. "Drainage effective, but this is a temporary asure, he needs ergency surgery."
He paused.
"Thoracotomy, cardiac repair."
Once again, the ergency hall fell silent.
Thoracotomy, cardiac repair?
These words, spoken lightly by Li Min, as if saying "asure blood pressure." But everyone present knew the weight of these words, this was not a surgical operation a town health center should undertake, nor one a county hospital could handle, it was a taboo only specialist doctors at provincial tertiary hospitals in Cardiothoracic Surgery dared to touch.
Zhou Daping looked at Li Min, then at the Elderly Director, his lips moving, wanting to say sothing but not knowing what to say.
The Elderly Director was also at a loss of what to do at this mont.
Li Min did not look at Zhou Daping, his gaze settled on the still fragile ECG line on the monitor.
"If we send him to the county hospital now, it will take at least one and a half hours; all these severely wounded will perish on the road, with no chance of survival." He summarized the current condition of the injured in the most straightforward language, "especially him, with his blood pressure unable to wait, pericardial drainage is unable to maintain for that long."
"All actions follow my command!" Li Min ordered calmly.
The Elderly Director took a step forward.
"How sure are you?"
Li Min did not answer imdiately, he looked at Zhou Fusheng’s ashen gray face, then at his own hands.
"Seventy percent!" he said.
The Elderly Director was silent for three seconds.
"That’s enough!" he said. "Do it!"
"Everyone hear this, don’t be afraid, don’t panic, follow my command, just give a helping hand!"
"Imdiately transport Zhou Fusheng to the Operating Room, surgery now! Draw blood for tests on the way."
"And imdiately transport Chen Dongxiu to the Operating Room, prepare for surgery, concurrent operations. I will do it, while doing Zhou Fusheng, you disinfect and lay sheets for Chen Dongxiu, be quick, I’ll co over right after finishing that side."
"Xu Dehou has just undergone closed thoracic drainage, cardiac compression temporarily relieved, monitor while awaiting surgery."
"Zhao Qiulin follows behind Xu Dehou, note his tourniquet ti, notify after one and a half hours."
"Other injured temporarily stay for observation in the ergency room!"
Upon finishing, Li Min began assigning tasks, each job specific to an individual.
After arrangents were complete, he and the Elderly Director hurried to the Operating Room.
The lights in the Operating Room ca on.
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