I'm just a veterinarian! You've unlocked the Great Physician System!

Chapter 468 One thing leads to another, a Yama's Match-3 combo, does it have to take one of them?!
"Dr. Ogawa! I'm here!!"

Yin Xiaoxiao was immediately very excited when she heard Zhang Lingchuan call her name.

Since many emergency room doctors are not very skilled at pericardiocentesis, could it be that Dr. Ogawa is planning to perform pericardiocentesis himself?

Although he never said he could perform pericardiocentesis, his silence often doesn't mean he couldn't!

You see, isn't it a C-section?

Previously, at Alibaba, a pregnant woman experienced a difficult childbirth.

In that situation, even if they were sent to the hospital normally, they might not survive. At most, saving one child would be considered a great achievement.

As a result, he managed to get 20% certainty and successfully got both the adult and the child to cooperate!
From that day on... no, it should be said that from the moment she met Dr. Ogawa, she felt that Dr. Ogawa was unfathomable.

It's like a treasure trove waiting to be explored!
"You come over here and take charge of this motorcycle driver. If he experiences ventricular fibrillation again, call me immediately! I'll go and assist Professor Xu with a pericardiocentesis!"

Zhang Lingchuan shouted at Yin Xiaoxiao at this moment.

The motorcycle driver here finally got his red tag back, and Zhang Lingchuan looked up at the old woman; there were only twenty-five seconds left on the countdown.

He was not skilled at pericardiocentesis.

In the early stages of training in the system simulation space, even the possibility of cardiac tamponade could not be guessed.

After all, the person was already unconscious, with no breathing or pulse, so there was really no way to tell the difference.

So his first action was to perform CPR.

It was only later that they realized the other person had cardiac tamponade, and even with his perfect CPR, he had ultimately gone astray and gone further astray.

The situation is now critical.

He really didn't know how to perform pericardiocentesis, not even at the beginner level, because in the system space, he only had a few failed attempts, and the rest were all done by Dr. Zhao, who had a background in cardiac surgery.

After all, many emergency room doctors don't know how to perform pericardiocentesis.

But this is the real world, and my skills are not restricted. There is still a way to save this person in this desperate situation.

That means he acts as the eyes, and Dr. Xu acts as the hands, and the two of them work together to perform the puncture.

[The current host has completed three emergency rescue missions at the clinical death stage. A fourth patient at the clinical death stage has been discovered. The host can do their best to save the patient. Upon completion of the mission, the treasure chest and professional reputation will be awarded as usual.]

This was the notification that popped up after he completed the resuscitation of the third clinical death stage.

System scan complete.

[Patient's name: Dai Yinghua]

[Patient's gender: Female.]

[Patient's age: 65 years old.]

[Patient's condition: Coma, respiratory and cardiac arrest...]

[Patient diagnosis: fracture, cardiac tamponade; currently in the clinical death stage.]

[System prompt: This patient is a cardiac tamponade patient from a car accident and needs immediate pericardiocentesis. This procedure may seem simple, involving just a needle to remove fluid, but it is clinically difficult and carries considerable risks!]

For example, the target is small and the margin for error is low. The surgical target is a narrow, drainable space within the pericardial cavity. If the needle is mistakenly inserted into the myocardium or a cardiac chamber, it can cause puncture bleeding or life-threatening complications. In ultrasound, ultrasound guidance is the preferred method. The approach (subxiphoid, left ventricular apex, parasternal) is selected in real time using ultrasound, and the progress of the needle tip is observed in real time.

Simultaneously, ultrasound should be used to locate the nearest fluid window, usually the point closest to the chest wall is preferred, and parasternal or apical points are often shorter and less risky than the xiphoid process in many cases. However, the coronary arteries near the myocardium should be avoided.

……

Currently, it is recommended that if the host lacks proficiency in pericardiocentesis, they should choose an experienced physician to assist them, thereby increasing the patient's success rate.

It's still a precise scan.

The system also offered the same approach as him.

He currently has X-ray vision and ultrasound hearing, so he has no choice but to take a risky step.

Successful people survive, while death prevails!
"Understood! Good luck, Dr. Ogawa! Just call me anytime if you need anything!"

Yin Xiaoxiao nodded.

He then quickly took over the patient that Zhang Lingchuan had just rescued.

The ventricular fibrillation was successfully treated.

However, there is still a possibility of ventricular fibrillation recurring.

Yin Xiaoxiao really felt that she had never been this busy, not even when she was in the hospital.

She is both the two children and now she is the motorcycle driver.

What's next that belongs to her?!
When will the hospital ambulance arrive?!
"Is Dr. Ogawa going to be on screen again?"

"He can't possibly do pericardiocentesis too, can he?"

"In fact, emergency room doctors, especially those working outside the hospital, rarely perform pericardiocentesis. In cases like this, performing ultrasound while advancing the device increases the success rate. However, portable ultrasound and conventional ultrasound in hospitals differ significantly in terms of structure, performance, image quality, diagnostic accuracy, and application range."

"Yes, the success rate might be much higher if it were done in a hospital, even if you know a little bit about it, but the success rate will be greatly reduced if it's done like this now."

The viewers in the live stream were talking.

This is actually what Xu Mengli is worried about.

Portable ultrasound in ambulances is mainly for rapid screening and immediate decision-making, while standard ultrasound in hospitals is for accurate diagnosis and quantitative measurement.

The former quickly determines whether there are life-threatening lesions such as bleeding, pericardial effusion, or pneumothorax, while the latter clarifies the nature of the lesion, hemodynamics, tissue structure, and grade diagnosis.

To put it simply, portable ultrasound has low resolution and a lot of noise. It can only identify large structures such as pericardial effusion >100 mL, and it is almost impossible to accurately measure volume or blood flow.

Hospital ultrasound can identify small structures down to the millimeter level, distinguish different types of effusions or masses, display deep organs in layers, and accurately measure volume, area, blood flow velocity, etc.

In short.

The portable ultrasound in an ambulance is like a telescope on the battlefield, while the ultrasound in a hospital is like a microscope in a laboratory. The former emphasizes speed, scanning ability, and the ability to save lives; the latter emphasizes detail, accuracy, and qualitative analysis.

For a doctor like her who only has a superficial understanding of the subject, using a telescope on the battlefield won't cut it; a microscope is needed!

But now that there's no microscope, she has no choice but to perform surgery using a telescope!
"Teacher Xu, the patient needs to undergo pericardiocentesis now."

Zhang Lingchuan said this after he arrived.

"Yes! What are your thoughts, Professor Ogawa?"

Xu Mengli looked at Zhang Lingchuan.

Everything is now ready.

She was actually preparing herself mentally for the pericardiocentesis.

“Teacher Xu, I will help you operate the ultrasound, and you can do it.”

Zhang Lingchuan said.

After all, Teacher Xu is more skilled than him!

He stabbed someone to death in the system space in the early stages, so even now, despite having special abilities, he still has some psychological trauma.

"it is good!"

Xu Mengli originally thought that Dr. Xiaochuan was going to make a move.

To my utter surprise, the other party actually said they would do it to me.

Now that all the tools are ready, and lives are at stake, let's get started!

[X-ray eye activated.]

[Ultrasound ear type B activation.]

"The needle is inserted at the junction of the left edge of the xiphoid process and the costal margin, about 1 to 2 cm from the tip of the xiphoid process, which is this spot."

Zhang Lingchuan pointed to the old woman's location.

The portable ultrasound in the ambulance was indeed blurry, but one's own ultrasound ear and X-ray eye are superior to those of hospital machines.

It is equivalent to the most accurate testing instrument of its kind currently available in the world.

Therefore, he can see exceptionally clearly.

Honestly, if he had even a basic level of skill, he would have gone straight for it this time.

Unfortunately, he didn't even reach the beginner level.

If your hand accidentally shakes, that could be fatal.

"clear."

Xu Mengli's technique was not very proficient.

But I do understand some of the relevant theories.

The needle is inserted at an angle of 15° to 20° to the body surface. Aspiration is performed while inserting the needle, with the pattern being to aspirate once every 2–3 mm of advance.

If dark red, non-clotting blood is drawn, it means the blood has reached the pericardial cavity. If bright red, spurting blood is drawn, it means the blood has penetrated the heart cavity, and the needle needs to be withdrawn immediately!
Normally, the needle can enter the pericardial cavity when it is inserted about 3–5 cm.

In clinical practice, there is also a principle of erring on the side of being too superficial rather than too deep.

Simply put, the puncture needle should generally not exceed 5 cm; if it goes too deep, it can easily puncture the heart.

"Teacher Xu, continue. Stop when I tell you to stop. You're in the right position now!"

Zhang Lingchuan was already a little hesitant to move forward when he saw Xu Mengli's hand.

"it is good!!"

Xu Mengli chose to believe Zhang Lingchuan.

Although it's already five centimeters long.

And so, the two worked together.

The countdown continues.

【4, 3...】

It has even reached three seconds.

The reason, of course, is that Xu Mengli's skills are rusty and she's not very confident.

Zhang Lingchuan didn't dare to disturb them.

They were afraid the other party would have to do another round of mental preparation.

In just a few dozen seconds, you really can't give up halfway; if you do, you're doomed.

"This is the most nerve-wracking thing I've ever watched!"

"Damn it, I'm off work, what's with this suffocating feeling during surgery?"

"That was incredible! That emergency rescue was absolutely amazing!!"

"If these four people can be saved tonight, I dare say this will be a landmark case of out-of-hospital emergency care nationwide!"

"This is a typical case; I think it's no exaggeration to call it a miracle in the history of pre-hospital emergency care!"

Viewers in the live stream are eagerly anticipating it.

It also gave it extremely high praise.

As for the Provincial People's Hospital.

Huang Xiangning's heart was also pounding.

It appears calm on the surface, but is actually beating wildly inside.

"Vice President Huang, the ambulance will arrive in six minutes."

Fan Wang offered a reminder.

Actually, sixteen minutes isn't a long time.

But for some reason, today felt incredibly long, like sixteen centuries had passed. "It's done! The dark red liquid! It didn't solidify immediately!"

Huang Xiangning had actually been observing the operation the whole time.

At the scene, after Zhang Lingchuan said, "Teacher Xu, this is it," Huang Xiangning saw that the liquid was indeed extracted.

The most direct sign of successful pericardiocentesis is the aspiration of fluid from the needle or catheter; if the fluid is bloody or serous, this is the most direct indication of success!
The typical symptom is a continuous backflow of fluid during aspiration. The fluid is dark red or bloody, but it does not coagulate immediately because the fibrinogen in the pericardial fluid has been depleted.

This is also different from cardiac blood.

If the drawn blood clots immediately, it means the needle entered the heart cavity, not the pericardial cavity.

"I'll do CPR!"

The pericardial effusion disappeared, and the diastolic restriction of the right atrium or right ventricle was relieved.

At this point, you can start CPR.

"Drip-drip-"

Changes were observed in the electrocardiogram monitoring, with increased QRS complex voltage and a more stable rhythm.

And the heartbeat reappeared.

"Awesome!!"

"Good heavens!!"

"That's incredible! They actually succeeded!!"

"It's on fire! It's really on fire! I thought this was doomed! I never expected it to succeed!!"

It's late at night.

Some doctors among the viewers immediately started shouting.

That would be just as exciting as scoring a goal in a football match!
[Number of viewers watching the provincial TV station's "Medical Path to Success" live stream: 42929.]

The number of viewers in the live stream also reached 42,000, nearly 43,000.

[Top 36 in Live Streaming Category Ranking]

And it squeezed into the top 50 of the live streaming category list, reaching number 36.

And all of this happened within ten minutes.

Ten minutes ago, the live stream had fewer than 300 viewers; ten minutes later, it had reached 40,000.

Sometimes, popularity really does happen in an instant.

The main thing is that the rescue was truly amazing.

How many emergency room doctors and medical students are there in the whole country?

Right now, almost 90% of the viewers in the live stream are them.

Another 10% comes from natural flow.

These medical students usually don't watch live streams much, especially late at night, but this one is absolutely amazing; missing it would be a real loss.

"We...we did it..."

Xu Mengli's mind was actually completely blank.

She couldn't believe she had actually succeeded.

But the reality is that this old woman, who was destined to die, was actually saved.

How many are there?

Four now!!

"Yes...it was a success."

Each time he uses a special skill, it's like burning a thousand calories in the gym, roughly equivalent to running fast for over an hour or swimming continuously for two hours.

He was truly exhausted.

"Mr. Ogawa, you should rest for a bit. I'll go check on Tesla to see if there are any seriously injured people there."

Xu Mengli felt a little guilty.

Tonight, Mr. Xiaochuan really pushed the limits of his map-running skills.

"Okay, Ms. Xu, you can go ahead now. I'll be right there."

Zhang Lingchuan waved his hand.

"This...this is a ruptured liver and massive abdominal bleeding!!"

Upon examination, it was discovered that the woman had no visible injuries but deep bruising on her abdomen. A sense of foreboding filled the air. After the ultrasound examination, Xu Mengli was completely dumbfounded!
"?"

"No way! Are you kidding me?!"

"Well, it seems like the King of Hell is going to take someone away tonight, isn't he?"

"A ruptured liver and massive abdominal bleeding—how can we save him? This is in the wild! He can't possibly survive!!"

The photographer was really busy tonight.

However, he also went along to take photos.

After the test results were shown in the live stream, the medical staff and viewers were furious.

Liver rupture, massive intra-abdominal bleeding of 2000-4000 mL, rapid decrease in effective circulating blood volume, hemorrhagic shock, tissue hypoxia, acidosis, insufficient myocardial perfusion, cardiac arrest, this process from onset to death generally only takes 5-10 minutes!

"My mother..."

The next moment.

He slapped his forehead hard.

Because a countdown had already started appearing above the passenger side of the Tesla that Master Shi had pulled out.

"What's wrong, Dr. Ogawa?"

Master Shi asked in confusion.

"Master Shi, hurry up and help the other stretcher bearer lift the injured passenger in the Tesla into the car."

Zhang Lingchuan knew that there was no time to lose.

The other person needs to be operated on immediately.

"Oh? Oh! Then I'll head over right now!"

Master Shi was a little confused.

But as Dr. Xu just said, the on-site command is now in the hands of Dr. Xiao Chuan.

[Ding! The current host has used a stamina potion!]

After Zhang Lingchuan finished using a bottle of stamina potion, he immediately got up from the ground.

"Huh? Load it into the car? Well... okay!!"

Xu Mengli was bewildered when Dr. Xiaochuan said he would lift the woman into the car.

But what was he planning to do by lifting it onto the car?

hospital.

"?"

Huang Xiangning also looked a little puzzled.

"?"

"??"

"Should we take him to the hospital? It's too late now!"

Viewers in the live stream thought Zhang Lingchuan might be planning to take him to the hospital.

But sending it over at this point would essentially be equivalent to sending a corpse over.

With a ruptured liver and massive abdominal bleeding, it's absolutely impossible for someone to survive long enough to reach the hospital.

"Is Dr. Ogawa perhaps trying to stop the bleeding with his bare hands?"

Suddenly, one of the viewers had a brilliant idea.

After all, Dr. Ogawa had previously survived a liver rupture by manually stopping the bleeding.

"Professor Xu, we need to prepare for surgery immediately!!"

However, what Zhang Lingchuan said next shocked everyone!

"Operation??"

Xu Mengli looked at Zhang Lingchuan in shock!
Normal pre-hospital emergency care absolutely prohibits open abdominal surgery.

Because the bleeding cannot be stopped, liver rupture bleeding mostly comes from the deep liver parenchyma and hepatic venous system. In the field, it is impossible to clamp or suture. Once the abdominal cavity is opened, the rate of blood loss will increase sharply, and the patient will die faster.

At the same time, the lack of sterile conditions on site, and the contamination of air, gloves and instruments can easily cause sepsis. Even if the patient is temporarily saved, they will die from infection later.

In this situation, circulatory support cannot be maintained, and laparotomy must be performed in conjunction with blood transfusion, endotracheal intubation, anesthesia, monitoring, and hemostatic materials.

None of these are available on site.

Therefore, their out-of-hospital emergency team's mission is not to cure, but to slow down the death curve.

“If we don’t open her abdomen and perform surgery now, this person will definitely die! She’s only in her thirties, she’s her parents’ daughter, and more likely her child’s mother! So we have to try!!”

Zhang Lingchuan said earnestly.

At the same time, he picked up a scalpel.

"This……"

Xu Mengli's mind was buzzing.

"Teacher Xu! You only have the right to talk about infection if you're alive, right? Leave this to me! Go and check on the driver of that Honda!"

After this surgery, the Honda driver over there should be prepared for ventricular fibrillation!

It's truly a chain reaction.

The King of Hell's Match-3 Game Set!
but no matter!
He's doing everything he can to make sure even the King of Hell can't get rid of him!

"Indeed, only those who are alive have the right to talk about infection."

"This sounds like something a military doctor would say. My grandfather was a military doctor, and he once said that only survivors on the battlefield are qualified to talk about infection!"

"I'm a military doctor, and I have to say this statement is absolutely true: Infections only happen when you're alive; what good are infections when you're dead!"

"From a military medical university, when liver rupture and bleeding exceed 2000 mL, the success rate of non-surgical hemostasis is almost zero. If we continue to wait for ambulance transport for 5 minutes, the heartbeat will definitely stop. If it were me, I would also go straight to surgery!"

"But there's basically no chance of saving him. The bleeding is so heavy, he's already on the verge of death. And how can you suture him in this kind of environment? He won't survive! I saw the video of him resuscitating someone with one hand on each arm last time! Even if you try to stop the bleeding manually, it's still very risky!"

"If it were me, I would give up. My family might be okay with it, but if they're not, it could even ruin my career."

Viewers in the live stream were having a heated discussion.

"Initiate remote communication immediately! I need to contact Xiaochuan right now!!"

Huang Xiangning was also very excited.

Because the chances of saving this person are extremely slim!

Having open abdominal surgery is tantamount to ruining yourself!
……

(End of this chapter)