top student at medical school

Chapter 314 Who's been here? (Please subscribe)
"Xiao Fang, what a coincidence! We just ordered some late-night snacks to eat together." Fang Ziye ran into Deng Zhi, the balding fat man, as soon as he came out of the emergency room.

Deng Zhi is the chief resident of the surgical clinic in the emergency department. He is chubby, but his bald spot on his head is even more innocent than that of his mentor, Yuan Weihong, which shows that the emergency department is a very demanding place.

"Brother Zhi, I have a big appetite, I hope you won't go hungry if I go?" It's past midnight, and this place for a late-night snack is probably a hospital or similar institution.

As we all know, being a doctor is not only a mental job, but also a physical one.

"Hey, I just had a craving. I'll introduce you to a brother and a sister." Deng Zhi waved to Fang Ziye generously, indicating that he was welcome to come over.

After throwing the tissues he used to wipe his hands into the black trash can, Fang Ziye thought for a moment and said, "Let me guess, is it Sister Ning Shuang and Sister Piao Piao?"

Ning Shuang is the chief resident of the EICU, while Guo Piaopiao is the chief resident of the emergency internal medicine clinic. Both of them are female!
However, it seems that many people in the emergency department do not treat Ning Shuang as a girl, but rather as a tough guy.

"Hey, I already told you I'd introduce you to a brother. This guy, Shuangye, drinks beer by stomping on it with his feet." Deng Zhi corrected Fang Ziye's wording again.

However, Ning Shuang, who had just gone out to look for Deng Zhi, overheard these words. With her neat short hair, she immediately rolled up her sleeves and came over, speaking in a somewhat rough accent: "Deng Zhi, what do you want?"

That's definitely a Northeastern accent.

"I was wrong, Master Shuang..." Deng Zhi quickly begged for forgiveness.

Perhaps because there were outsiders present, and everyone was considered an innocent victim, Ning Shuang didn't take it seriously.

Fang Ziye pretended that he was just there to freeload a meal.

This was Fang Ziye's first time having dinner with colleagues from other departments. Although it was a late-night snack, the conversation between Ning Shuang and Guo Piaopiao that Fang Ziye overheard after entering the emergency department's on-call break room was quite explosive.

There were teenage girls with ruptured fallopian tubes, women in their forties bringing their teenage "boyfriends" to the emergency room for abortions, and even cases of dislocations at night due to overly provocative positions.

I need to get ping-pong balls or something...

In short, modern people really know how to have fun.

However, after chatting with Ning Shuang for a while, Guo Piaopiao, whose hair reached her shoulders and who was wearing a long dress, glanced at Fang Ziye and, since they were discussing the topic of boyfriends and girlfriends, asked, "Does Dr. Fang have a girlfriend?"

Although Fang Ziye is the chief resident of trauma surgery, he has only recently taken office, so not many people have met him yet.

Since the emergency department is the transit point for resident chiefs, Deng Zhi and his colleagues have more or less an impression of the resident chiefs of various departments in the hospital.

Fang Ziye immediately sensed that Sister Piaopiao was lusting after him, and said with a smile, "I've got it, otherwise I would definitely ask Sister Piaopiao to introduce me to someone. With the resources Sister Piaopiao has, she would definitely introduce a good one."

As long as the meaning is expressed accurately, the subsequent flattery is actually irrelevant.

No one would introduce another woman to someone who already has a girlfriend after only meeting them once.

Upon hearing this, Deng Zhi immediately said, "Sister Piao Piao, I...I'm single..."

Fang Ziye could tell that Deng Zhi might have a crush on Guo Piaopiao, but Guo Piaopiao wasn't particularly interested in Deng Zhi...

"You? Just stop ruining my best friend's life." Guo Piaopiao said with disgust, mainly because Deng Zhi's appearance was indeed quite pathetic.

Upon hearing this, Deng Zhi turned his grief and anger into appetite and began to eat voraciously.

Then Ning Shuang and Guo Piaopiao discussed some other topics, such as what kind of cosmetics are best for wrinkles caused by staying up late.

This meager salary is all going towards maintaining this appearance...

However, just as the group was enjoying their meal, a loud shout came from outside: "Emergency! Massive bleeding! Urgent consultation with vascular surgeons and trauma surgeons is needed..."

Upon hearing this, all four of them froze in unison.

Fang Ziye quickly stepped back from the table and began to put on his work clothes and a mask.

Then he said, "Brother Zhi, you guys eat first, someone's calling us from outside..."

"Okay!" All three of them gave him pitiful looks.

Actually, the chief resident of the emergency surgery and emergency internal medicine wards isn't that busy; they only get busy when patients are admitted to the wards.

Fang Ziye didn't waste any words and directly opened the door to the lounge.

Emergency patients with massive bleeding usually request an emergency consultation with a specialist to stop the bleeding. In such cases, there is no need for Deng Zhi and others to join in.

As soon as Fang Ziye stepped out, he immediately saw bloodstains on the floor near the emergency department registration desk, with the bloodstains leading towards the emergency resuscitation room.

At the same time, Fang Ziye's consultation phone rang.

Fang Ziye immediately answered the call and changed his mind to running: "I'm in the emergency room, I'll be there soon."

Fang Ziye hung up the phone after saying that.

Then he took out disposable examination gloves from the right pocket of the white coat and prepared to put them on.

When Fang Ziye arrived at the emergency room, he saw that even with several doctors in white coats pressing on the patient, blood was still gushing out.

"I can't hold her down. Has the vascular surgeon arrived yet?"

"Should we take him to the operating room immediately?" The doctor's white coat, which was being pressed, was stained with blood from the patient's spurting blood.

Upon seeing this, Fang Ziye put on a glove for his right hand at the fastest speed he had ever done!
He quickly went to the bedside and glanced at the patient's condition, knowing that it was very serious.

The cause of the sharp object injury is unknown. At this moment, there is still a sharp, deformed steel piece in the patient's lower left abdomen. After cutting through the surface skin and fat, it also cut into a blood vessel.

At first glance, this appears to be damage to the left femoral artery.

But in reality, the patient's bleeding was far more complex than that. "Hemostats, open the debridement kit!"

“This is not a simple femoral artery injury; applying pressure to stop the bleeding will not work,” Fang Ziye quickly instructed the nurse.

Fang Ziye, wearing a white coat and a pre-issued inpatient chief badge, exited with exceptional decisiveness.

With this identity, the nurse assisting him did not hesitate to tear open the wound cleaning kit and tracheotomy kit, and brought over the hemostat that Fang Ziye had asked for.

Another on-duty nurse who had just finished her emergency consultation call rushed over.

When Chen Jiameng in the surgical clinic saw Fang Ziye, he said, "Xiao Fang, what should we do? If this bleeding can't be stopped, he'll die. This is acute vascular injury and blood loss..."

Fang Ziye didn't reply; he had no energy to be distracted at the moment.

My gaze followed the general direction and trajectory of the steel plate as it was inserted, analyzing the possible anatomical locations of the damage and any potential vascular injuries.

The blood vessels in the lower abdomen have a very complex course. The aorta branches into the left and right common iliac arteries, which in turn branch into the internal and external iliac arteries.

The medial and lateral iliac arteries have many branches, and the femoral artery is just one of them. This patient's arterial injury is definitely not a simple femoral artery injury. Manual pressure hemostasis is only suitable for simple single vessel injuries. It cannot be used to stop bleeding from multiple vessel injuries.

Fang Ziye's current proficiency in hemostasis is level 4. In addition to the operation, he also has some hemostasis concepts.

Perhaps these ideas are not as brilliant as those of Wu Xuanqi, who is more skilled in vascular surgery, but Fang Ziye still made a rather bold attempt based on his own understanding.

The femoral artery is a branch of the external iliac artery, and one of its largest branches.

The internal iliac artery is located closer to the midline of the abdomen. Given the current angle of the steel plate inserted into the patient, it should not cause damage to the internal iliac artery!
However, this is just speculation.

However, even if it was just a guess, Fang Ziye could only treat it as a correct condition.

The temporary clamping and hemostasis is achieved directly from the source, which means that the steel plate is used to make an entry point to blindly penetrate into the body and locate and clamp the external iliac artery.

Artificial clamping of the external iliac artery, if done within a very short time, has negligible impact, and this is the fastest way to achieve hemostasis.

My thoughts were racing, but in reality, only five seconds had passed.

Fang Ziye then made his move: "Based on the current angle of the steel plate embedding in the patient, the probability of damage to the external iliac artery system is relatively high. I suggest directly clamping the external iliac artery."

As Fang Ziye spoke, he directly inserted the hemostat.

Similar to blunt force puncture, the blunt-tipped hemostat in Fang Ziye's hands was like a sharp weapon, quickly piercing into the patient's body.

Upon hearing this, Chen Jiameng, who was standing nearby, said, "Dr. Fang, you're the professional, you handle it!"

"I'll explain the situation to the family later!"

"Does this external iliac artery injury fall under your orthopedics department or vascular surgery?" Chen Jiameng asked.

Specialized treatment is a point that must be clarified now.

Fang Ziye can follow the emergency rescue procedure, which is a temporary treatment outside the specialty for the purpose of rescue, but after the temporary treatment is completed, he still needs to return to the specialty.

Fang Ziye didn't reply. Instead, he used the hemostat to stir around inside the patient's body for a while, and after breaking through several muscle gaps again, he opened up the distal end of the hemostat.

After moving the forceps up and down and feeling that the wall he was touching was the anatomical tissue of a blood vessel, Fang Ziye opened the hemostat and then clamped it without hesitation.

This probing technique is actually a flexible application of a relatively advanced physical examination technique.

Once you reach a relatively proficient level in physical examination, you can even feel the subtle pulsations of blood vessels, making it relatively easy to determine whether a blood vessel is made of a specific material.

After clamping the pressure, Fang Ziye immediately released his right hand and said, "Dr. Chen, please release the pressure first. If this patient has an injury to the external iliac artery system, the bleeding should be slowed down immediately."

"A small amount of bleeding is just a small amount of residual blood in the blood vessel lumen, which is harmless."

"Oh. Okay!" Chen Jiameng let go of her hand.

He is an attending physician in geriatric surgery, which rarely handles emergencies; it's a separate subspecialty. Emergency cases in geriatric surgery are typically categorized under general specialty emergencies.

After all, you can't just put him in geriatric surgery instead of cardiac surgery just because he's old and has aortic dissection...

After Chen Jiameng stepped back a short distance, he found that the spurting blood had disappeared, with only a small amount of bleeding remaining.

"The guess is probably correct. After the bleeding site is treated, the patient's blood pressure fluctuations will tend to stabilize in this type of hemorrhagic shock."

"But those who need blood transfusions still need them. Based on the amount of bleeding at the scene, the patient's blood loss has reached the level of shock."

While explaining the effectiveness of his operation, Fang Ziye continued to warn the others not to let their guard down.

After observing for a while, everyone finally saw that the patient's blood pressure was maintained at around 85 systolic!

Thank goodness it didn't keep falling.

Chen Jiameng immediately said, "Contact the blood bank right away and apply for emergency blood matching. We need red blood cells and good plasma, the more the better!"

"Tell them that the patient has lost at least 3000ml of blood!"

"Establish intravenous access immediately..."

As Chen Jiameng said this, the doctors in his own department of the emergency department immediately nodded and thanked him. They said, "Dr. Chen, Dr. Fang, thank you for your hard work. We will make proper arrangements for the rest, except for the surgery."

In fact, the emergency rescue tasks belong to the emergency department.

However, there was really no other way to save this patient except to stop the bleeding, and even temporary pressure to stop the bleeding was ineffective, so the on-duty doctor in the emergency department had no choice but to ask Chen Jiameng for help.

Chen Jiameng did not reply. Although he had not been of much help, he had completed his task.

With a sigh of relief, Chen Jiameng glanced at his white coat, which was now stained beyond recognition, gave a wry smile, and said to one of the emergency room staff, "Brother Liang, I'll have to borrow your white coat again. I can't use it anymore."

"It's alright, we have plenty of white coats in our emergency department, all kinds of sizes." The man called Brother Liang had a very kind look in his eyes.

While speaking, he glanced, intentionally or unintentionally, at the hemostats inserted into the patient's body, and found it rather unbelievable that such an operation could be performed by such a young doctor.

Fang Ziye then answered Chen Jiameng's earlier question about the classification of the disease: "Dr. Chen, the subsequent surgical treatment for this patient should be handled by the vascular surgery department. I have never seen our department handle the iliac artery system. If it is simply below the femoral artery, then it is under our department's jurisdiction."

"Okay, sure!"

"Thank you so much, Dr. Fang." Chen Jiameng didn't call Fang Ziye "Little Fang" today.

"Of course, Brother Meng..."

Chen Jiameng and Fang Ziye went to the emergency surgery clinic to wait for them.

The situation here is still not very clear, and Fang Ziye is not a god.

We cannot determine with the naked eye that the patient's subsequent surgery will not require the involvement of trauma surgeons.

When Dr. Mitch from the vascular surgery department arrived at the emergency room from the lounge as quickly as possible, it had been less than a minute since the call ended, which was considered very timely.

Even so, Mickey seemed to realize that he was still a little late.

I glanced at the hemostat on the patient's lower abdomen; the handles were on the outside, but the tips were deep inside.

Mickey felt a chill run down his spine and asked, "Who has been here?"

This is a procedure that most vascular surgeons cannot perform; he has only seen a few professors perform it at specific times.

(End of this chapter)