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

Lynn's pupils contracted slightly.

Ha, politicians.

Grant released his grip and even stepped aside.

"Everyone."

He turned to face the five attending physicians who were still arguing.

"The Speaker's condition is deteriorating. Since the attending physicians present have not yet reached a consensus..."

He glanced at Lynn.

"Then let the young people who are willing to take action go first. Time waits for no one."

All five doctors looked at Lynn at the same time.

Their gazes differed.

There was shock, anger, and disdain.

But no one said, "I'll do it."

The monitor's alarm was getting more and more urgent.

Blood pressure 61/30.

Heart rate 155.

Life is slipping away at an almost audible speed.

[You can choose from the following world lines]

[A: Ignore everyone and forcibly perform emergency open-chest surgery. (Reward: General skill points, which can be used to enhance skills below Master level)]

[B: Force the attending physicians to authorize you before performing the surgery. (Reward: Slightly increase your physical fitness)]

[C: Go back to the corner. There are five attending physicians here. It's not your turn, an intern, to step forward. (Reward: The contempt of the crowd)]

[D: Expose Grant's true intentions on the spot, informing everyone present that this chief of staff is exploiting the medical chaos for political gain. (Reward: Restart)]

Four roads.

Two of them have meat to eat.

One is useless, the other is courting death.

The person in the bed had blood pressure that had dropped to 58/28.

Lynn had about thirty seconds to convince the five attending physicians.

Thirty seconds later, the multiple-choice question will no longer exist.

Because the dead don't need to be saved.

Lynn believed they could tell that not one of these American doctors remembered the Hippocratic Oath they had taken.

If blood pressure drops any further, the heart will stop.

If your heart stops, everything is over.

Therefore, the first step is not to open the chest.

It's about attracting traffic.

Closed thoracic drainage.

28Fr chest canal, left fifth intercostal space, mid-axillary line.

"What are you doing—" The attending physician from the trauma department stood in front of the trolley.

"Closed thoracic drainage." Lynn walked past him and tore open the sterile seal of the disposable drainage pack.

"Advanced trauma life support (ATLS) is the first-line treatment for hemorrhagic shock complicated by progressive hemothorax. If you think this shouldn't be done, stop me now."

In all guidelines, chest tube drainage is the only undisputed first step in the case of unstable penetrating chest trauma complicated by hemothorax.

The real controversy lies in what to do after attracting traffic.

But that happened later.

Someone pulled the attending physician in the trauma department back, and he took a step back, choosing to remain silent.

On the monitor, the blood pressure number jumped again.

54/26.

Lynn picked up an iodine-soaked cotton ball and tore open the piece of shirt under the patient's left armpit.

Disinfection took three seconds.

Slide your left index finger along the upper edge of the ribs to locate the position.

The bullet hole is located in the fourth intercostal space, slightly lateral to the midclavicular line. The drainage point must be selected at least one intercostal space below the bullet trajectory to avoid the contaminated area of ​​the bullet trajectory. At the same time, the characteristic of blood accumulating on the posterolateral side due to gravity when lying supine should be taken advantage of.

Fifth intercostal space, mid-axillary line. Within the safety triangle.

This judgment took one second.

Using a No. 10 blade, a three-centimeter skin incision was made along the upper edge of the sixth rib.

The incision is made above the next rib. The intercostal nerve and blood vessel bundles run in the groove at the lower edge of each rib, so entering from above will perfectly avoid them.

Blunt dissection of the intercostal muscles with curved clamps.

But Lynn only used the pliers once before switching to his fingers.

"Fingertip Blunt Separation Technique - Master Level".

He probed his index finger into the intercostal space, with the pad of his finger touching the upper edge of the sixth rib, penetrating layer by layer the external intercostal muscle, the internal intercostal muscle, and the innermost intercostal muscle. The texture and tension of each of the three layers of muscles were different under his fingertip.

Then comes the parietal pleura.

The final thin film.

The moment the fingertip pierced the pleura, dark red blood gushed out.

It was warm and served in large quantities.

The latex sap soaked through his fingers, down his wrist, and onto the cuffs of his gloves.

Lynn remained unfazed.

Rotate your index finger around the pleural tear to confirm there are no adhesions, then slide the 28Fr silicone chest tube into the chest cavity along your finger.

The tube head is oriented towards the upper rear, towards the costophrenic angle.

Head nurse Patricia came over, connected the water-seal drainage bottle, and then connected it to negative pressure suction.

Dark red blood gushed out along the transparent tube.

The liquid level in the water-sealed bottle rose at a rate visible to the naked eye.

The drainage bottle has graduation lines on its side.

300 ml.

500 ml.

800 ml.

……

It's still rising.

The trauma room was silent for a few seconds.

Everyone stared at the blood gushing from that tube.

That wasn't seeping blood. It was gushing out.

This indicates that there is an active source of bleeding within the pleural cavity, and the opening is not small.

But the traffic generation was effective.

The blood accumulated in the pleural cavity was released, the pressure was relieved, and the left lung began to re-expand.

The numbers on the monitor finally changed.

Blood pressure 64/34.

Blood oxygen 88.

They were pulled back from the edge of the cliff.

This step gave him more time to complete the subsequent treatment.

"Initial drainage volume exceeded 1,000 ml, with continuous active bleeding."

Lynn reported to the five doctors:

"According to the EAST (Eastern Association for Trauma Surgery) guidelines, an initial drainage volume of more than 1500 ml, or a continuous output of more than 200 ml per hour, is an absolute indication for emergency thoracotomy."

He glanced at the drainage bottle.

It's still rising.

"At the current rate, it will break 1500 within three minutes."

No one refuted the five points raised.

Because he was citing the Eastern Association of Trauma Surgeons' written practice management guidelines.

This is not his personal judgment, but the consensus of evidence-based medicine in the entire North American trauma surgery community over the past thirty years.

The attending physician in the trauma department spoke:

"...I'm instructing the operating room to prepare."

"It's too late."

Lynn said.

It will take at least five minutes to get them to the operating room.

Blood preparation, docking, and anesthesia induction take another five to ten minutes.

Speaker Dawson's blood pressure was barely kept at 64 thanks to drainage, and it could collapse again at any time if the chest tube gets blocked by blood clots or the bleeding rate increases.

He can't last twenty minutes.

"Open here."

The attending physician from the cardiology department raised his voice: "You want to perform open-chest surgery in the emergency trauma room?"

"Emergency thoracotomy. Left anterolateral incision."

Lynn has already expanded the disinfection area of ​​the surgical site, applying iodine solution from the left sternum all the way to the posterior axillary line.

"Trauma Room No. 1 has a fenocerto retractor, negative pressure suction, a blood bank for blood preparation, and the head of the anesthesiology department is present. The hardware conditions are sufficient."

He paused.

"All we're missing is someone willing to take action."

These words struck a nerve with every doctor present.

No one responded.

Grant, the chief of staff in the gray three-piece suit, smirked slightly.

He enjoys watching these kinds of scenes.

"I need an assistant."

There were more than a dozen people in the trauma room.

Five attending physicians, three resident physicians, four nurses, one respiratory therapist, and one head of anesthesiology.

No one responded.

The graduation mark on the drainage bottle has exceeded 1200.

one second.

two seconds.

three seconds...