"Upper gastrointestinal bleeding! Fluid replacent and prepare two units of O-negative blood. Contact the Gastroenterology Departnt to prepare for endoscopic hemostasis. We’re taking the patient right over."
Liu Banxia, who was initially startled, quickly reacted and shouted these instructions.
The people around also sprang into action; none of them had anticipated this young man suddenly vomiting blood.
"Blood pressure 90/50, heart rate 110, oxygen saturation 98%," Xu Dan quickly reported.
"Don’t worry, you probably have upper gastrointestinal bleeding. We’ll replenish your blood and fluids to raise your blood pressure imdiately. Then, we can find the bleeding point using a gastroscope and stop the bleeding," Liu Banxia said to the young man after establishing the IV line.
The young man, who had just vomited blood and was now pale, nodded and lifted his sleeve to wipe his mouth.
"Dr. Liang, maintain the airway at all tis. His vital signs are still acceptable for now. We have ti," Liu Banxia instructed, nodding forcefully at Liang Xiaolin.
"Dr. Liu, the blood is here!" a nurse exclaid, running over with a blood bag she had fetched.
"Start a rapid transfusion to prevent hemorrhagic shock! Everyone, push the gurney! Xu Dan, lead the way and hold the elevator!" Liu Banxia ordered.
Gastrointestinal bleeding isn’t terrifying in itself. What’s dangerous is severe bleeding leading to hemorrhagic shock. If the patient loses consciousness, airway protection is crucial, or they might asphyxiate during the next episode of hematesis.
Moreover, when a patient goes into shock, their vital signs plumt. This is the body’s attempt at self-preservation, but in cases of hemorrhage, it ironically worsens the condition.
He had just examined the vomited blood; it wasn’t a large amount. With fluid and blood replenishnt already expanding the blood volu, endoscopic hemostasis was much safer than open surgery.
While pushing the patient toward the Gastroenterology Departnt, Liu Banxia took out his stethoscope to listen to the patient’s bowel sounds. They were hyperactive, confirming his suspicion.
Normally, intestinal peristalsis occurs 3-5 tis per minute. However, Liu Banxia had just auscultated 5 bowel sounds in less than a minute.
Combined with the recent hematesis, this indicated a significant accumulation of blood in the gastrointestinal tract, accelerating bowel motility. Fortunately, the current blood loss wasn’t critical, and his blood pressure had risen to 100/60.
"What’s the situation?" asked Xiao He, the Deputy Director of the Gastroenterology Departnt.
"Ca in for an ankle fracture, suddenly vomited blood, no dical history," Liu Banxia explained.
"Considering the patient’s long-term habit of dieting, upper gastrointestinal bleeding is suspected. Fluids and blood have been replenished, and his blood pressure has been raised."
"Why wasn’t he brought in sooner? An ulcer would typically present with symptoms," Xiao He said, donning his gloves.
"The patient often takes ibuprofen, which probably masked the pain symptoms of the ulcer," Liu Banxia said with a wry smile.
Xiao He paused, then nodded, proceeding to administer a simple pre-procedure anesthetic.
Gastroscopy is an uncomfortable procedure. Imagine having such a thick tube inserted down your throat. Therefore, a local anesthetic is sprayed to minimize the patient’s gag reflex and discomfort.
Although Xiao He was the Deputy Director of Gastroenterology, he had been a Chief Physician for many years, and his hands were remarkably steady. Liu Banxia and the others watched the monitor intently.
As the gastroscope passed through the pharynx, entered the esophagus, and descended into the stomach, the screen displayed a sea of blood, interspersed with clots.
Liu Banxia let out a breath of relief; at least their prediction was accurate. Now it was up to Xiao He to decide how to stop the bleeding.
Even though gastric bleeding was confird, locating the source and achieving hemostasis were the most critical steps. With so much blood in the stomach and coating the gastric mucosa, irrigation was necessary first.
After careful irrigation, Xiao He located a small vessel actively spurting blood.
"Found it!" Liu Banxia couldn’t help exclaiming.
Xiao He understood his excitent but still shot him a warning glance.
Although the vessel wasn’t large, the bleeding was significant. Therefore, Xiao He chose not to use local drug spray or electrocoagulation, opting instead for hemoclips.
As the clips secured the vessel and surrounding tissue, and the applicator was detached, everyone watched the monitor. The patient’s vital signs gradually improved.
DING! Patient admission completed (2/20).
Gained: 50 Experience Points, 100 Diagnostics Skill Proficiency, 100 Endoscopy Skill Proficiency.
"Director Xiao, you’re truly amazing!" Liu Banxia said, giving a thumbs up.
"Then you can leave now," Xiao He glanced at him.
"Alright, alright, we’re leaving now! After this is all done, he still needs to be sent back to our departnt for X-rays and a cast," Liu Banxia said quickly, leading Liang Xiaolin and Xu Dan out.
Watching him go, Xiao He couldn’t help but shake his head. This kid is quite a handful; Zhou Shuwen certainly has his work cut out for him.
"Thankfully, his ulcer wasn’t too severe. Otherwise, he might have needed an interventional procedure or even open abdominal surgery," Liu Banxia said once they were outside.
"Goodness... Talk about a lucky break, huh? If his ankle hadn’t fractured, he might have started vomiting blood at ho. He could have been dead by the ti an ambulance arrived," Liang Xiaolin remarked with a sigh.
Liu Banxia nodded. "That’s highly probable. It also reflects common attitudes towards illness these days. Hospital avoidance and dication misuse really delay diagnosis and treatnt for many patients."
"That patient Dr. Wei took to surgery probably only ca because he couldn’t bear the pain any longer. He was always taking ibuprofen whenever he felt unwell. People shouldn’t self-dicate indiscriminately. While a hospital check-up might cost more, at least it’s the safer option."
"He self-dicated at ho, masking his ulcer symptoms. Combined with his recent dieting, it led to this crisis."
"Pharmacies used to have couplets saying they’d rather let dicine gather dust on the shelves than have it misused. But now? ’Spend fifty yuan, get six free eggs.’ You top up your loyalty card, they’ll give you even more."
"All sorts of antibiotics and painkillers are bought over the counter without a second thought. Continuous consumption leads to drug resistance. Then, minor ailnts can gradually escalate into serious conditions."
"Pharmacies are incredibly profitable. Don’t you rember? In Jinshui District, on that single street leading to the hospital, there were five pharmacies. They must all be raking it in, otherwise, they wouldn’t stay open."
"That’s why you need to work hard. By the way, have you heard anything? Who’s coming over from Cardiothoracic Surgery? Besides Chen Xuehai, there should be so other big shots, right?" Liu Banxia asked.
Liang Xiaolin shot him a look. "I haven’t asked, how would I know?"
"If you don’t know, you don’t know. No need to get worked up. Xu Dan, you’ll stay here with the team and hold the fort. You’re the nurse responsible for this patient’s care, understand?" Liu Banxia said, looking at Xu Dan.
"Consider it done!" Xu Dan affird, her expression serious.
The doctors from the Gastroenterology Departnt found this amusing. They didn’t know much about the Ergency Departnt, but they now suspected it was a rather lively place on a daily basis.
Upon their return to the Ergency Departnt, they found that in the short ti they’d been away, six patients requiring debrident had accumulated. With only Liu Banxia and Liang Xiaolin available, they had to handle them.
Liu Banxia managed four patients. By the ti he went to the second treatnt room, Liang Xiaolin had just finished her second.
This frustrated Liang Xiaolin. My speed has clearly improved a lot, so why am I still so much slower than him?
"Ah, I only had two burgers, a bowl of congee, and three tea-leaf eggs this morning. How am I still a bit hungry?" Liu Banxia mused aloud.
"How much more can you possibly eat? I have one burger and half a bowl of congee at most," Liang Xiaolin said helplessly.
"The main thing is, it’s only ten o’clock. Hamburgers just don’t stick to your ribs. Stead buns are much more substantial," Liu Banxia lanted.
Liang Xiaolin couldn’t be bothered to respond. His appetite is just insane. He eats enough for two of , easily. Where does it all go? His stomach doesn’t even look that big.
"Is the patient who was vomiting blood stabilized?" Head Nurse Wang Ying asked, walking over.
"He’s with the Gastroenterology Departnt; it was a bleeding gastric ulcer. After they’re done, he’ll be sent back to our Ergency Departnt. It’ll be good experience for our nurses," Liu Banxia reported.
"That’s good. Our young nurses are competent with routine care, but they definitely need more diverse training," Wang Ying nodded.
"Sister Wang, I was thinking. Once the residents on their standardized training arrive, how about we have them practice at the Ergency Departnt’s triage desk? That would free up one nurse," Liu Banxia suggested.
Wang Ying chuckled. "Are you worried I’d take it the wrong way? Don’t overthink it; that’s actually a great idea. If we do end up short-staffed on nurses in the coming days, that’s my problem to worry about. The team will just have to pull together for a bit."
"Sister Wang, once we beco a comprehensive receiving hospital, how much do you think our workload will increase?" Liu Banxia asked curiously.
"At least threefold, and that’s a conservative estimate for ergency patient volu. We’ll also have many non-ergency walk-ins, and that number is harder to predict," Wang Ying replied.
"Sister Wang, that much? We’re going to be exhausted," Liang Xiaolin comnted.
"And that’s a conservative estimate. So, Liu Banxia, you’ll need to be particularly diligent then. More people an more issues, understand?" Wang Ying said.
Liu Banxia nodded. "Definitely. Sister Wang, you’ll have to support . I’m already struggling a bit. There’s just not enough ti, and once I’ve gathered enough data, I still have to write my thesis."
"Many people have high expectations of you, so you need to push yourself. Don’t worry about the nursing side; Zhou Li and I will handle that. Your job is to manage the incoming residents properly. Just rember what a ss you all were when you first arrived," Wang Ying teased.
"That’s precisely why I’m worried. Today’s young doctors are all so fiercely independent," Liu Banxia said with a wry smile.
It was true. Young people were increasingly independent and assertive. For him, lacking significant managent experience, this would be a real test.
User Comments
0 comments from readers