American Medicine: I survived the death knell thanks to the devil.

Chapter 102 Where's my ambulance?

"Without an anesthesiologist, local anesthesia simply cannot suppress the pain from cutting open the four fascial compartments."

"The patient is delirious; the severe pain will directly trigger the vagus nerve reflex, causing cardiac arrest!"

Lynn took the number ten razor blade from the nurse.

"Then go make the call and tell them that I've saved this leg."

Brian's eyes reddened.

After studying medicine for seven years, he discovered for the first time that there was no corresponding chapter for the phrase "too late" in the textbook.

He dialed the phone.

busy tone.

hang up.

Dial again.

Still busy signal.

The phone almost slipped from my hand.

He looked up at Lynn.

Lynn had already applied chlorhexidine to the patient's calf, from the knee to the ankle; the entire leg was covered in disinfectant.

"Hold down on his shoulders and hips."

Curly-haired Brian gave up on the phone.

Bend over and hold the patient down.

He no longer has any rules to follow.

All that remained was this dying leg and a madman about to operate.

"Bite down."

Lynn stuffed a folded piece of gauze into the patient's mouth.

Time: 7:28.

The blade fell.

Lateral approach.

Start by making an incision four fingers below the knee joint, then cut longitudinally along the outer edge of the tibia, making a single cut all the way to the end, about twenty centimeters long.

The skin cracked.

The moment the deep fascia snaps open is like the lid of a pressure cooker exploding.

Dark red blood and edema fluid gushed out, accompanied by a strong metallic smell.

It splashed onto Lynn's mask, Brian's white coat, and the medical cart a meter away.

The patient's body arched violently, and a muffled roar, which the gauze could not block, was squeezed out from deep in his throat, like a wild beast being crushed.

Brian, with curly hair, pressed down hard, his arms trembling, sweat dripping onto the patient's chest.

Lynn's knife didn't stop.

The fascial septa of the anterior lateral chamber and the lateral chamber are opened along the lateral incision.

The sound of scissors tearing open fascia rang out continuously: "Swoosh, swoosh, swoosh—"

Each sound was accompanied by a gush of edema fluid and muscle swelling.

Both fascial compartments are released simultaneously.

Lynn then turned to the inside.

Second knife.

Make a longitudinal incision along the posterior medial border of the tibia.

This cut is even deeper.

The posterior tibial artery and tibial nerve are located between the soleus muscle in the shallow posterior chamber and the flexor digitorum longus muscle in the deep posterior chamber.

If you cut off even a millimeter off-center, you'll sever the artery, and the blood supply to that leg will be completely cut off.

Cut two millimeters off-center, severing the nerve, causing permanent loss of sensation in the sole of the foot.

In a standard operating room, this step requires a senior attending physician to use an electrocautery knife to separate the layers under conditions of tourniquet inflation and a clear surgical field.

Lynn used a No. 10 cold blade.

There was no tourniquet.

There is no electrosurgical unit.

The surgical field was full of blood.

As the blade sliced through the fascia, his left index finger had already probed into the gap between the muscles.

The fingertip touched the pulsation of the posterior tibial artery.

Go around it.

My fingertip slid along the outside of the artery for two centimeters and encountered a cord-like structure.

Tibial nerve.

Go around it.

Fingers spread a safety passage between the two lifelines.

The scissors passed through this passage, cleaving open the fascia of the deep posterior chamber.

"laugh"

The last fascial compartment is released.

All four cubicles were opened.

Muscle gushed from the incision, its color visibly changing from bluish-purple to dark red.

The blood is flowing again.

The entire lower leg resembled that of a drowning person who had just been pulled ashore, now breathing again.

"Dorsalis pedis artery."

Brian, with curly hair, touched the patient's instep.

My fingers are still trembling.

But this time, the pulse was no longer weak.

Strong, powerful, and even.

Like a restarted engine.

"Pulse has returned."

His voice was hoarse, with a rising intonation at the end, and trembling uncontrollably.

Lynn covered the two incisions with damp gauze.

"Write the surgical record and contact the orthopedics department to arrange for a delayed closure."

He straightened up and glanced at the calf that had been cut open by two long incisions.

The muscles were exposed to the air, like a pomegranate that had been cut open.

But every muscle is alive.

As long as you're alive, that's better than anything else.

"This leg has been saved."

Time: 7:36.

Brian with curly hair stood still, his hands hanging at his sides.

The gloves were covered in blood and edema fluid.

He suddenly realized that his legs were also shaking.

corridor.

Lynn took off his gloves and put on a new pair.

Both trauma rooms have been fully treated.

Number one, fasciotomy of the fourth compartment was performed, limb preservation was successful.

Number two, brachial artery repair, hemostasis completed.

Number three remains.

The hand laceration involved tendons, nerves, and blood vessels.

Asking a first-year resident to handle this independently is as difficult as defusing a bomb.

He had prepared for the worst.

Push the door open.

Trauma Room No. 3 was very quiet.

A kitchen helper wearing a greasy apron was lying on the hospital bed.

Cheng Lan sat on a low stool, with a surgical magnifying glass placed in front of her.

Hold the tweezers in your left hand and the needle in your right.

She was performing surface reinforcement sutures on the last tendon.

Lynn stood to the side without saying a word.

The two completely severed flexor digitorum superficialis tendons have been core-sutured using the modified Kessler method.

The flexor digitorum profundus tendon was partially torn, but its continuity was preserved and surface reinforcement was performed.

The needle spacing is uniform, and the entry and exit points precisely avoid the blood supply area of the tendon sheath.

The nerves are fully identified and protected.

The three-millimeter lateral wall tear of the ulnar digital proper artery has been sealed with interrupted sutures.

The irregular edges caused by the mixer blades were trimmed into neat cross-sections.

This rough yet skillful handling of complex wounds bears the mark of the Veterans Affairs Hospital.

Good enough.

It's so good that most attending physicians and supervising doctors can't find any fault with it.

But Lynn is not the vast majority.

"Did you have tendon repair surgery?"

Cheng Lan kept her head down, her hands never stopping.

"Two flexor digitorum superficialis tendons were ruptured, and one flexor digitorum profundus tendon was partially torn."

"We repaired the two completely severed tendons first, preserved the continuity of the deep tendon, and reinforced the surface."

"Does it refer to the intrinsic nervous system?"

"It was avoided. There was a three-millimeter lateral wall tear in the ulnar digital artery, which has been repaired. The radial side is intact."

"Did you play the local abortion yourself?"

"Median and ulnar nerve blocks at the wrist. Textbooks recommend ultrasound guidance, but there was a 40-minute wait in the ultrasound room, so I used anatomical localization to perform the scan blindly."

Lynn nodded.

"Your ulnar nerve block insertion point was half a millimeter too far inward."

Cheng Lan paused for a moment while holding the needle.

"—What?"

"Your blocking effect is very good, which means that the drug diffusion has compensated for the deviation."

"But you inserted the needle between the flexor carpi ulnaris tendon and the ulnar artery, which is a standard approach."

Lynn's gaze fell on the kitchen helper's hands.

"This patient's ulnar artery runs slightly medially, deviating from standard anatomy by half a millimeter. Your needle tip grazed the adventitia of the ulnar artery."

"It wasn't torn, but it was wiped clean."

He glanced at the traces left on the discarded needle.

"Drawing back doesn't restore health, right?"

"----right."

"Because you're wiping the outer membrane, not the lumen. That half-millimeter difference is more a matter of luck than skill."

Cheng Lan's fingers tightened around the needle holder.

She was the Veterans Affairs Hospital's Emergency Department Resident of the Year.

The attending physician there, after watching her performance, commented that it was "perfect".

The person in front of me, with just a few words, broke down "perfection" into "good luck".

She wanted to argue.

But when she received the injection, she did feel a very slight elastic resistance for a moment.

At the time, I thought it was the fascia layer.

Looking back now—

It is the adventitia of the ulnar artery.

A tingling sensation spread from the back of my head to my fingertips.

Lynn did not continue speaking.

He glanced at the flexor digitorum profundus tendon surface reinforcement she was stitching.

"Your surface reinforcement needle insertion point is at the three o'clock position on the tendon sheath."

"The avascular zone of the flexor digitorum profundus tendon is between 12 o'clock and 2 o'clock. Your needle tract passed through the tendon sheath's blood supply zone, which will affect the postoperative gliding within the tendon sheath."

"Adjust the needle insertion point to the one o'clock position, avoiding the tendon knot."

Cheng Lan lowered her head and re-examined her stitching.

He's right.

The three o'clock direction is the standard approach taught by the Veterans Affairs Hospital.

When dealing with battlefield-level brutality, the three o'clock position is faster and safer.

But for a restaurant kitchen helper, fine motor skills are more important than battlefield survival rate.

She should adjust the injection point according to the patient's occupation.

She didn't.

Because she took the Department of Veterans Affairs' standards as the standard.

Just like Brian took Tufts' rules as gospel.

Cheng Lan's chin tightened.

I immediately adjusted the angle of the needle holder, moving the needle insertion point from three o'clock to one o'clock.

Seeing this, Lynn turned and walked towards the door.

It paused for a moment at the door frame.

"After suturing, use an aluminum plate to fix it in the functional position. After four weeks, transfer to the hand surgery department for a follow-up examination of the tendon's gliding ability."

This girl is nice.

"it is good."

Cheng Lan's voice was a little lower than before.

This is the first reaction of someone with extremely high technical pride when faced with an overwhelming gap in skill.

Time: 7:50.

Lynn walked out of Trauma Room No. 3 and leaned against the wall in the corridor.

All three machines have been processed.

Total time: 47 minutes.

The bathroom door at the end of the corridor opened.

Emergency room attending physician Smith walked out, supporting himself on the door frame.

His face was sallow, and he was covered in cold sweat.

Severe diarrhea made his legs weak and his vision blurred.

He took a deep breath and looked up.

Prepare for a disaster when the emergency department is completely out of control.

Three critically injured patients, three inexperienced newcomers, plus his absent attending physician.

The medical malpractice hearing tomorrow is already beckoning him.

But there were no alarms in the corridor.

Smith leaned against the wall and dragged his heavy steps to Trauma Room Number One.

The door was half open.

Two longitudinal incisions were made in one of the lower legs, exposing the muscles directly to the air, which were covered with wet gauze.

The heart rate and blood pressure on the monitor were very stable.

Brian with curly hair sat on the stool next to him, his eyes red-rimmed, like a raw recruit who had just been through the baptism of war.

Smith's jaw nearly dropped.

What I was about to witness was a four-chamber fasciotomy.

A four-chamber fasciotomy was performed in the emergency room!

He stiffly turned his head to look at Trauma Room Number Two.

The brachial artery repair is complete, and Sofia is suturing the muscle layer.

The patient's radial artery pulse is strong.

A large patch of dark red bloodstains on the floor stretched from the foot of the bed all the way to the doorway, a testament to the danger that had just occurred.

Trauma Room No. 3

Cheng Lan has completed the full repair of the tendons and blood vessels in her hand and is now performing the final skin suturing.

Three high-risk surgeries that could kill someone at any moment.

Everything is stable.

Smith slowly turned his head and looked at Lynn, who was leaning against the wall.

Lynn was taking off her blood-stained blue gloves and casually tossing them into the medical waste bin.

Smith opened his mouth, his throat dry and sore.

He wanted to ask, "Who gave you this authorization?"

The point is, "This is a serious violation of hospital emergency procedures."

But the words stuck in his throat.

He knew better than anyone that without Lynn, all three men would have died or been crippled.

As the attending physician on duty, he was not without his share of troubles.

"Are all the patients stable now?"

Smith's voice was hoarse, with a hint of ingratiation that he himself was unaware of.

Lin Enbai took a pen out of his pocket and quickly wrote down the medical orders on the handover form.

"Check the blood potassium and myoglobin levels of patient number one to prevent kidney failure caused by crush syndrome."

"Perform a bedside ultrasound on bed number two to confirm blood flow at the vascular anastomosis site, and then transfer the patient to the vascular surgery department for observation."

"The cast for bed number three has been applied, and broad-spectrum antibiotics have been prescribed to prevent infection."

Lynn turned around and slapped the handover form directly onto Smith's chest.

"signature."

"Then go and report to the hospital director about your outstanding leadership in the emergency room."

Smith looked down at the sheet on his chest.

Once the consent forms are signed, he, as the attending physician, will undoubtedly bear a significant share of the credit for the miraculous treatment of these three terminally ill patients.

The noose of medical malpractice has instantly become a ladder for year-end performance evaluations and promotions.

He gripped the form tightly and swallowed hard.

"Okay, I will handle all the follow-up paperwork."

Smith took over the case and relinquished command of the emergency room; any further credit would go to Lynn.

It was a fair deal, and he was willing to accept it.

He stepped aside, like a junior doctor waiting for orders, and gave Lynn the spot in the middle of the corridor.

The call for the orthopedic consultation was only answered at this point.

The nurse answered the phone. The caller was an attending orthopedic surgeon who sounded very impatient, asking which operating room number and what level of anesthesia was used.

The nurse glanced at the severed lower leg in room number one.

She glanced again at Lynn in the middle of the corridor.

"No.

The nurse spoke calmly into the microphone.

"Dr. Lin has already opened four fascial compartments in the emergency room, and the leg has been saved."

"Just arrange for someone to come and extend the closure tomorrow."

hang up.

Head Nurse Patricia came over with a steaming cup of coffee and handed it to Lynn.

"How is it?" Patricia asked.

"One is a proper man, the other a sycophant."

Lynn took the coffee and took a sip.

A strong bitter taste washed over my mouth.