White armor

Chapter 775 The Triple Death
The surgical incision was about 20cm long, and a large gauze pad had been inserted into the abdominal cavity.

After finalizing the surgical procedure, Luo Hao inserted his left hand into the abdominal cavity to explore again.

Chen Yan was already familiar with his dog-like temper and had long guessed that he would do this, so he wasn't surprised.

The patient's spleen surface was smooth and no rupture was palpable. A large, obvious rupture was palpable on the surface of the left lateral lobe of the liver, which was initially diagnosed as a liver rupture. Further exploration of the right side of the liver surface along the falciform ligament did not reveal any obvious rupture.

Obvious granular nodules were visible on the surface of the liver, indicating cirrhosis.

A gauze pad was inserted into the abdominal cavity. Luo Hao pressed the gauze pad down with his fingers, and Chen Yan then made a transverse incision along the right side of the abdominal wall.

Fully exposing the abdominal cavity facilitates exploration and treatment.

"Xiao Luo, it's been a long time since I did surgery with you." Chen Yan was slightly excited.

The circulating nurse vaguely saw that Chen Yan's beard seemed to stand up and puncture the sterile mask.

"This old man's ideas are really strange," the circulating nurse thought with disdain.

Although the incident of Chen Yan's bad temper had actually passed, it was still fresh in the circulating nurse's mind.

If possible, she wouldn't mind tearing Chen Yan to pieces.

"Director Chen, I've been a little busy lately." Luo Hao said casually as he investigated and helped Chen Yan with his tasks, explaining his trip to the Qinling Mountains to see the bamboo.

The operating room was filled with the acrid smell of electrocautery burning tissue. The regular beeping of the monitor and the high-frequency buzzing of the ultrasonic scalpel intertwined, like a sonata.

Chen Yan stood at the surgeon's position, his forehead already covered in a fine layer of sweat, and the operating light cast a cold white halo around his dark blue sterile suit.

Gradually, he focused on the surgery, ignoring Luo Hao's gossip.

This surgery is quite difficult; Chen Yan can complete it, but he will have to give it his all.

"Ultrasound scalpel." Chen Yan reached out, his voice slightly tense.

Unexpectedly, the ultrasonic scalpel didn't land directly in my hand; there was a slight lack of coordination.

Luo Hao didn't immediately hand over the instruments. Instead, he gently touched a spot on the left triangular ligament with tweezers: "Director Chen, please wait a moment. Tear this part first to reduce traction."

His tweezers precisely peeled back a thin membrane, revealing the avascular area beneath.

Chen Yan was taken aback for a moment, then understood.

After severing the deltoid ligament, the ultrasonic scalpel landed in Chen Yan's hand.

The "beep beep" sound emitted during ultrasonic scalpel engagement became smoother, and the collagen fibers of the ligaments quickly broke apart under ultrasonic vibration, with the cut surface as neat as if it had been laser-cut.

"Slow down!" Luo Hao suddenly whispered.

Chen Yan's ultrasonic scalpel had already cut open the S4 branch of the left hepatic vein, and dark red venous blood gushed out instantly.

Before Chen Yan could react, Luo Hao's left index finger had already firmly pressed on the puncture site, while his right hand simultaneously handed over a 5-0 Prolene thread.

This is an anatomically abnormal location, not Chen Yan's fault.

He was so comfortable during the surgery that he momentarily forgot himself.

"Small round needle." Luo Hao's voice was so calm that it didn't sound like he was trying to save someone from a massive hemorrhage.

While Chen Yan was frantically threading the needle, Luo Hao slightly adjusted the angle of his index finger, which both stopped the bleeding and left room for suturing.

After three needles, the wound was repaired perfectly.

After observing for another ten seconds or so and seeing no active bleeding, Chen Yan finally breathed a sigh of relief.

Although not fatal, it will at least prolong the surgery time.

This is an emergency, and we cannot afford to be careless at all.

The patient's life or death may be decided in those few minutes.

“Continue.” Luo Hao loosened his fingers, and bloodstains drew eerie patterns on his gloves.

He picked up the suction device and precisely aspirated the blood from the surgical field, while gently lifting the root of the left hepatic vein with forceps: "Director Chen, it's safer to advance from here."

When Chen Yan's ultrasonic scalpel started again, the rhythm was noticeably more steady.

Luo Hao kept the suction head in the optimal position, which neither affected the operation nor hindered the removal of smoke and blood.

His left hand held forceps and gently pulled the tissue from time to time, each movement clearly revealing the key anatomical structures.

The surgery was so satisfying... Chen Yan felt exhilarated.

"If all the doctors under my command could reach Luo Hao's level, how wonderful that would be," Chen Yan couldn't help but think.

“Blocking band.” Luo Hao suddenly reached out.

Chen Yan was taken aback. It was something he would need in three minutes, yet Luo Hao had reminded him so early.

The scrub nurse prepared the occlusion bandage, and Luo Hao assisted Chen Yan with the surgery.

It was just in time to use it when the barrier band was opened and placed on the sterile kidney dish.

Luo Hao took the yellow latex tube from the tray himself and deftly looped it around the hepatoduodenal ligament. Just as Chen Yan was about to take over, Luo Hao had already tied the knot.

The two said in unison, "15 minutes."

During the second block, just as Chen Yan's linear stapler clicked, Luo Hao handed over the second one: "The S2 liver pedicle is 3mm higher than the usual position."

Sure enough, after Chen Yan adjusted the angle as instructed, the cutting process went exceptionally smoothly.

The instant the left lateral lobe of the liver was completely removed, Luo Hao's suction device was already waiting below the cut surface. Amidst the hissing sound of blood being sucked away, he suddenly turned the suction head towards the right lower lobe of the liver: "Director Chen, there's bleeding here."

Chen Yan examined the area carefully but found nothing.

Luo Hao took the tweezers and parted a fold in the hepatocolonic ligament—a tiny bleeding point was slowly oozing blood. After the precise "buzzing" sound of the ultrasonic scalpel cauterizing the bleeding, Luo Hao finally put down the instruments: "You can close the abdomen now."

Throughout the entire process, Luo Hao never overstepped the boundaries of his assistant, yet he made every crucial step flow smoothly.

When Chen Yan was sewing the last stitch, she found that the back of her sterile gown was soaked with sweat, while Luo Hao's sterile gown remained dry and crisp.

"This surgery was done really fast," Chen Yan thought to himself.

Luo Hao handed over the warm salt water, and Chen Yan rinsed his face.

No active bleeding was found, and the surgery was declared essentially complete. At the same time, the patient's blood pressure returned to normal, and the ventilator alarm on the monitor disappeared without a trace.

just.

As the skin was being stitched up, blood continued to seep from the needle puncture site, and the patient unsurprisingly fell into the death triad—hypothermia, acidosis, and coagulation disorder.

"Director Chen, I'll go down first to prepare for the ICU. After you close the abdomen, the patient will be intubated and transferred to the ICU."

"Okay, thank you for your hard work, Xiao Luo."

Luo Hao didn't have time to be polite with Chen Yan and left with Chen Yong and Zhuang Yan.

"Director Chen, you're quite cunning. Did you feel embarrassed to send patients to the ICU yourself, so you asked Professor Luo to come up?" the circulating nurse asked.

"No way," Chen Yan said while carefully closing his abdomen. "You don't understand unless you've had surgery."

"I don't understand?"

"Everyone says that you operating room nurses and anesthesiologists are the most knowledgeable about surgery, but you don't know anything at all," Chen Yan said bluntly.

"You think you know everything!" The circulating nurse directly expressed her negation with an affirmative sentence.

"Hey, there's been a joke going around lately, I heard it from Xiao Zhou in our department." Chen Yan wasn't angry. He continued suturing meticulously, without using his assistant at all.

"What joke?"

"Xiao Zhou went on a blind date, and guess what the girl asked him after they met?"

"Economic conditions?"

How much dowry can you give?

The anesthesiologist and circulating nurse guessed it.

"No, the girl asked if you're relatively single or completely single?"

"Hahaha," the anesthesiologist laughed.

After the surgery, the patient fell into a life-threatening situation, which was unavoidable. We still had to stay focused and resolve the problems after the surgery and surgery. At this point, telling a few jokes wouldn't hurt.

"Single is divided into relatively single and completely single? Young people these days are really playing games," the circulating nurse said.

"Unmarried or divorced? If divorced, are you still single and maintaining an ambiguous relationship with your ex-wife?" Chen Yan asked strangely while performing surgery.

"..."

"..."

That's incredibly impolite.

The anesthesiologist sighed. No wonder young graduate students these days are increasingly averse to blind dates. If he were asked these questions, he would probably have already lost his temper.

But he didn't expect that this was just the beginning.

After getting the answer, the girl asked Xiao Zhou if he was single because he already had someone he slept with, but was emotionally single.

"Holy crap!" The anesthesiologist was stunned.

That's a valid question.

He glanced furtively at the scrub nurse, their eyes met, and he quickly lowered his head.

"Then the girl asked if I was single and had a crush. By the way, what does 'crush' mean?" Chen Yan asked.

"Simply put, it's someone you have a crush on," the circulating nurse replied.

"Oh, you should have said so earlier. I looked it up online, and the explanations were all over the place," Chen Yan said. "So it turns out it's just a crush. Your explanation is a bit different from what I read online, but I think it's more accurate."

"Also, are there any single people who have boyfriends but no girlfriends?"

After praising him, Chen Yan immediately continued.

This question was so sharp that the anesthesiologist even doubted whether the person who said it was a girl from Sichuan.

Otherwise, where would such rich experience come from?

"Anything else?" the anesthesiologist asked.

"And that's not all. The girl asked Xiao Zhou if he was single only in this city?"

"How delicate!" the anesthesiologist exclaimed.

"Is there any point in asking that question?" the circulating nurse wondered.

“Of course it makes sense. There’s a surgeon in the next city who told the operating room nurses that he was divorced and even got a fake divorce certificate,” Chen Yan said.

"Isn't this a lie?!"

“Yeah, there are so many scammers these days.” Chen Yan reached out, and the thread scissors landed in his hand. “And then?”

"There's nothing more to it, it's just a fuss. By the way, Xiao Zhou's matter isn't over yet, don't interrupt me, I've had cerebral aerosol since the pandemic, I'm always forgetful."

"You've just gotten old, from a middle-aged man to an old man."

"..." Chen Yan paused for a moment, then sighed, but he ignored the circulating nurse's provocation, after all, he was the one who was impatient first.

"Xiao Zhou also encountered a problem: the girl asked him if he was single while in a marriage of convenience."

"This young lady is very experienced," the anesthesiologist remarked.

"It takes a lot of things to gain such rich experience."

"Yeah, Xiao Zhou got upset when asked about it and has refused to go on blind dates ever since, saying the world is too complicated and he feels he's still too naive."

As he spoke, Chen Yan paused for a moment, then shook his head.

"I've said too much. The main reason I asked Professor Luo to perform the surgery was to coordinate with him," Chen Yan said with a touch of emotion after finishing the last stitch. "You wouldn't understand that kind of tacit understanding. How should I put it? Like, Professor Luo needed a lumbar support bandage. You all knew you needed it and were prepared, but who could call him to get it on the operating table three minutes in advance?"

“There are so many details like this in this surgery. I usually take about two hours to perform similar surgeries. Today? All in all, it's only been an hour and ten minutes since I called Xiao Luo.”

"They even put a catheter in, didn't they?"

"Old Chen, can you please stop using the catheter?" The circulating nurse's face immediately darkened as she scolded him.

“Hey, to be honest, it’s not that you’re not skilled enough, I wouldn’t be able to get down there either,” Chen Yan quickly explained. “Besides, the patient is very likely to experience the triple threat of death, and will require postoperative care.”

"Nurse? You can't handle the workload in your department, and there's no one to back you up. Sending her to the ICU might be risky. It would be best if Professor Luo personally took care of her?" The circulating nurse knew what Chen Yan was thinking.

"Xiao Luo is skilled, but it's not like he would sit by the bedside and watch over her all the time. He has love."

"Ah, right, Old Chen, do you think Professor Luo's AI robot is really that amazing?" the circulating nurse asked.

"Of course it's awesome. If you don't believe me, go down with the patient in a bit, and you'll see for yourself."

true and false?

Many people in Professor Luo's AI robotics department know about it, but no one knows just how amazing it is.

Although there are occasional rumors, such as the Second Hospital being fined a lot of money for using drugs like digoxin during a surprise inspection, while the First Hospital was fined.

But everyone felt that it was Feng Zixuan's achievement.

As Chen Yan carried the patient downstairs, fearing something might go wrong, he put on a coat and followed closely behind.

Five or six people, including nurses, anesthesiologists, and surgeons, escorted the patient all the way to the ICU ward.

The bed was ready, and "Xiao Meng" indeed appeared in the ICU ward.

The bed being wheeled out of the operating room still reeked of blood and the acrid smell of burning tissue from the electrocautery, while the alarms from the monitors mingled into a jarring symphony.

"Xiao Meng's" sunglasses seemed to be gleaming. Chen Yan felt that its optical sensors were locked on the purplish face of the postoperative patient, and the infrared scanning module was drawing a body temperature distribution map.

"Core body temperature 32.1 degrees Celsius, PT value 28 seconds, arterial blood pH 7.18." Xiao Meng's voice was calm to the point of being cruel.

"Meets the diagnostic criteria for the death triad, with a survival probability of 17.3%." Xiao Meng turned his head and reported to Luo Hao.

Luo Hao nodded slightly, unsure whether he agreed with the data provided by "Xiao Meng".

"Professor Luo, I'll activate the emergency resuscitation protocol then."

"Okay." Luo Hao didn't reach out, but stood aside and watched.

Several unfamiliar-looking intensive care medical staff silently appeared around the patient's bedside.

One of them held an esophageal temperature probe, inserting it precisely into the patient's throat like a silver snake; the other held an intravenous puncture needle, simultaneously inserting it into the internal jugular vein, the needle tip reflecting three cold glints under the light.

No one spoke; the silence was unsettling.

Everyone present was a seasoned medical professional; they all knew how chaotic a resuscitation effort could be when faced with a patient exhibiting the triple threat of death.

But the rescue scene is now eerily quiet, with no one communicating even the most basic things.

Moreover, "Xiao Meng" didn't do anything; he just stared blankly at the values ​​on the electrocardiogram monitor and the ventilator.

"Director Chen?"

"Shh, those are all AI robots. Xiao Meng is the main unit; after the analysis, the other robots take action," Chen Yan whispered to the circulating nurse, knowing a little about the situation.

"Holy crap, is it this advanced?" the circulating nurse exclaimed in surprise, even swearing.

Unlike in science fiction movies, although silent, there are no metallic lights or shadows; it's more like a well-coordinated medical team performing emergency care.

"Professor Luo, I'm preparing to administer peritoneal irrigation with 38-degree Celsius warm saline at a flow rate of 2000 ml/hour." As "Xiao Meng" and Luo Hao communicated, the pale yellow liquid flowed into the patient's abdominal cavity through the triple filtration system, forming a fine vortex of bubbles in the transparent tubing.

“This…this will cause intra-abdominal hypertension…” the young resident doctor said, his voice trembling.

“It’s alright. Looking at the previous scans, the patient has no history of portal hypertension, and intra-abdominal pressure monitoring has already been initiated,” Luo Hao explained.

The ICU doctor scratched his head, wondering where to find previous scans.
A dozen minutes later, the circulating nurse noticed that "Xiao Meng" had a tablet computer in her hand.

Isn't it AI? Why use a computer?
But the circulating nurse soon realized that the tablet screen was the main control screen, and Luo Hao, who had been silent, needed to know all the data.

"Xiao Meng" is just a neural node.

The data stream on the main control screen poured out like a waterfall.

When the lactate level soared to 9.2, an AI robot adjusted the ventilator parameters, another AI robot was already injecting sodium bicarbonate, another AI robot wirelessly connected with the blood bank system to dispense plasma, and yet another AI robot was performing thromboelastography.

All the movements are completed within 10 seconds, so fast that the human retina can only catch a silver afterimage.

"Professor Luo, fibrinogen 0.72 g/L. Request for off-label use of recombinant factor VII, dosage 90 μg/kg." His voice remained steady.

"Over there at the medical office?" the circulating nurse whispered.

"Professor Luo has a good relationship with the medical affairs office, so he should have the authority."

As they were talking, they saw Luo Hao pick up his phone and call Feng Zixuan.

"Director Chen." Chen Yong walked over, holding an informed consent form in his hand. "This is a notification form for medication use outside the permitted scope. Please tell the patient's family to sign it so that the medication can be administered."

Chen Yan breathed a sigh of relief. He only had this much work to do, and it would be unreasonable not to do it.

He just wanted to see "Xiao Meng" and its AI robots carry out the rescue.

Chen Yan left the ICU with the notification form and hurriedly explained the situation to the patient's family.

He was an experienced man, and his explanation was detailed yet concise, emphasizing key points as needed, and he quickly got the patient's family to sign the papers.

As for those words of gratitude, Chen Yan didn't listen at all.

If the patient comes out alive, everyone is happy; but if the patient dies, the surgeon will inevitably face trouble.

Previously, he had to shoulder the burden himself, but now, with Professor Luo leading an AI robot to help him, Chen Yan is full of confidence.

Back in the ICU, Chen Yong had already received the notification form. After reading the signature on it, he put the notification form in the medical record.

One AI robot immediately administers medication to the patient. The moment the needle pierces the vein, another AI robot creates a 3D projection at the patient's radial artery, displaying the thrombin generation curve in real time.

The projection appeared on the tablet computer in "Xiao Meng's" hand, and Chen Yan was completely dumbfounded.

Real-time thrombin generation curve?
Has anyone seen this thing before?

As for how it was done, Chen Yan had no idea. He even suspected that he wasn't at the First Affiliated Hospital of China Medical University, but at Peking Union Medical College Hospital.

"Director Chen, I'll head back now." The anesthesiologist pulled the circulating nurse away, and they looked at each other one last time before leaving, seemingly reluctant to part.

"Xiao Luo," Chen Yan walked to Luo Hao's side, "what are the chances?"

There is no subject, but everyone knows what the subject is.

"It should be fine. It's just a triple threat of death. Our First Affiliated Hospital of Medical University has a very strong emergency and critical care team."

"!!!"

Chen Yan had no idea what Luo Hao was saying.

He even suspected that Luo Hao was working at the First Affiliated Hospital of Yin-Yang Medical University.

Strong emergency medical services? I've never seen that myself.

"Director Chen, please go ahead and do your work. I can't leave today."

"Isn't Xiao Meng being resuscitated?"

"I have to keep an eye on it; the system isn't very stable yet," Luo Hao said calmly, then narrowed his eyes slightly, and Chen Yan could vaguely see Luo Hao's smile beneath his mask.

"After all, it's an emergency, but the good thing is that Xiao Meng can help me a lot. You know, I have OCD. If I were to leave now, I'd be like an ant on a hot pan."

As Luo Hao spoke, he moved a chair over.

Chen Yan sighed and patted Luo Hao on the shoulder, "Then you go ahead and do your thing."

After dinner, Chen Yan still felt uneasy, so he returned to the ICU.

Luo Hao sat calmly by the bed, watching as an AI robot rapidly tapped on the patient's sternum.

What is this for?
Chen Yan walked over to Luo Hao and saw that the patient was already covered with a warming blanket, knowing that the patient had reached the rewarming stage.

"Director Chen, this is the vibration rewarming method, which can improve the efficiency of peripheral vasodilation by 37%," Luo Hao explained, while watching the ultrasound probe scan the hepatic veins for gas embolism.

When the core body temperature rose to 34 degrees, its ECG analysis module suddenly detected the QT interval abnormality 0.5 seconds earlier, and the electrolyte infusion rate immediately dropped from 120 ml/h to 80 ml/h.

"Coagulation function has initially recovered, PT 14.3 seconds," Luo Hao added, "but the probability of rewarming pulmonary edema in the lower lobe of the right lung has reached 89%, so the condition is still somewhat critical."

Is it critical?

Chen Yan doesn't think so.

Suddenly, a large amount of pink frothy sputum gushed out of the patient's endotracheal tube, meandering down the tube and creating a strange siphon effect in the ventilator circuit.

But Chen Yan did not panic. Instead, he quietly watched "Xiao Meng" treat the patient.

Under normal circumstances, if you see pink, foamy liquid in a ventilator, the person is probably mostly dead and beyond saving.

But today, Chen Yan felt certain of victory, a very strange feeling.

why?

Chen Yan watched as "Xiao Meng" handled the situation while pondering what to do.

I could faintly hear Luo Hao's steady breathing.

Correct!
Professor Luo didn't say a word, just quietly watched "Xiao Meng" make the decision. He knew what was going on!
Chen Yan calmed down and looked around. Chen Yong had already brought over a chair.

"Director Chen, let's sit down and talk."

(End of this chapter)