Knot (1)
The patient’s chest is revealed when the bandage is cut off.
The patient had a total of three stab wounds (wounds caused by being stabbed by a sharp object), one near the heart and one on the right lung, a short distance away.
‘How on earth are we going to solve this?’
Evian looked down at the wound and stuck out his tongue.
The golden time has already passed.
Even if he was a triple board thoracic surgeon, there seemed to be no way to save the patient.
At least it would be better if the surgical environment were more supportive, but in the current situation…
“The bleeding is still there. I need to perform a thoracotomy as soon as possible. “Please quickly disinfect Evian.”
“Ah yes.”
While Evian widely disinfected the stab wound and the surrounding area, Ki-Seok Choi carefully reviewed the surgical procedure.
There were only three blood packs brought from the Red Cross hospital.
Stage 2: The patient’s physical strength is almost at its lowest.
Evian’s assistant, a colorectal surgery specialist who hasn’t made up his mind yet.
Taking all of this into consideration, it was necessary to perform the surgery as quickly and efficiently as possible.
Ride, ride, ride.
The anesthesiologist who heard the news late brought the necessary drugs and tools and began administering general anesthesia.
Even while under anesthesia, he stared at Choi Ki-seok with a worried expression.
Patient’s serious condition.
He seemed very concerned about the fact that the procedure was performed in the back of an ambulance rather than in an operating room.
“The anesthesia is over… Mr. Choi, are you sure you’ll be okay?”
“I’m fine, but I’m worried that the patient is not.”
Choi Ki-seok smiled bitterly and continued.
“Thank you for your hard work under anesthesia. “Go back and rest.”
“yes? Are you serious? “Who takes care of my vitals?”
“I will check during surgery. It’s hard to move when there are a lot of people. “You fully agree that the space is small, right?”
At Choi Ki-seok’s words, the anesthesiologist looked at the ambulance and nodded.
“…All right. “I wish you good luck.”
After the anesthesiologist left, Ki-Seok Choi took a deep breath and looked down at the patient.
The preparation time for the surgery became longer due to many twists and turns.
To make up for this, we will have to work even harder.
But just as I was about to pick up the scalpel, I heard a familiar voice.
“Kiseok!
Jeong Seol-hwa rushed to the ambulance in a huff, her gown flying.
“why? What’s going on?”
“It’s not that, I just want to help.”
“You’re on duty. “Seeing patients in the clinic.”
“How do you examine a patient who doesn’t exist? “I’ll help with the surgery here and then go back when the patient comes.”
She wore surgical gloves and a mask and prepared to assist in the surgery outside the ambulance.
The two eyes staring at Choi Ki-seok were filled with determination that they would never back down.
“okay. “Then, will you take on the role of disinfection nurse?”
“huh.”
“From now on, we will begin left and right atrium reconstruction and hemothorax treatment for patients with thoracic trauma. “Meth.”
Choi Ki-seok used the scalpel given to him by Evian to cut vertically from the top of the patient’s neck to the solar plexus.
Suuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuu. Slam!
After making an incision, he worked with Evian to install a retractor on the surgical site. As the fixed retractor was pulled to the left and right, the skin opened and the sternum was exposed.
“Sulwha, keep opening the retractor. “Be careful because blood may splatter.”
Jiyiing.
Choi Ki-seok split the peach-shaped sternum in half with a chainsaw.
‘shit!’
It wasn’t a difficult task, but it was more time consuming than usual.
This is because I was worried that I might have an accident due to contact with Evian, who was assisting closely behind me.
The sternum split open, revealing the long-awaited breasts.
There was a sea of blood around the lungs and pericardium due to the stab wounds.
Chii Iik.
As the blood decreased with Evian suction, the surgical vision gradually became clearer. The first thing Choi Ki-seok did was, of course, inspect the damaged area.
After using the dragon’s eye zoom-in mode, his eyes soon glowed fiercely like an eagle’s.
“It’s a snowflake. Mosquito (vascular forceps).”
“okay.”
Click!
Choi Ki-seok tightly clamped the blood vessel in the ruptured right atrium with vascular forceps.
Then the amount of bleeding decreased noticeably.
“There is still some bleeding left, right?”
“yes. I think it’s in the left atrium. “I can’t see very well.”
Choi Ki-seok began to gently move the heart with forceps to find the bleeding site. Then, I discovered blood leaking from the lower part of the left atrium.
“ruler. Mosquito.”
“okay.”
Choi Ki-seok tied the blood vessel again with blood vessel forceps. But this time, unlike before, the bleeding did not completely stop. Blood continued to flow as if the faucet had not been turned off.
‘Then…’
He bit his lip and boldly reached out to his heart. Then, the patient directly applied manual pressure to the ruptured left atrium where the bleeding had not yet been stopped.
Sometimes direct pressure with the hand rather than vascular forceps was better at preventing bleeding.
“….”
“….”
In silence, everyone’s eyes were focused on Choi Ki-seok’s fingertips.
If the bleeding could not be stopped, the patient had no future.
There was a limit to the blood brought from the Red Cross hospital.
“Whew… that’s it.”
Choi Ki-seok stopped applying pressure and checked the wound.
The blood that had been leaking out obnoxiously finally stopped working.
It was barely an hour saved.
“Kiseok. “Do you see Beck’s triad (symptoms of jugular venous expansion, decreased heart sounds, and low blood pressure) in the patient?”
“It’s probably because I haven’t received treatment for a long time and I’m suffering from hypovolemic shock. First, put on a ventilator and mix with one ampoule of epinephrine.”
“okay.”
Jeong Seol-hwa, who received Choi Ki-seok’s order, moved quickly.
But it is that moment.
Clink.
The surgical tool fell to the floor with a metallic sound.
While Evian was assisting, he hit the container containing the surgical tools with his elbow.
“I made this stupid mistake… I’m sorry.”
“Once a surgical instrument falls on the floor, it cannot be used. “I’m sorry, Seolhwa, but could you please go to the operating room one more time?”
“It’s okay no matter how many times you do it.”
While Jeong Seol-hwa was away, the surgery was temporarily suspended.
Even Choi Ki-seok, who cut raw meat, could not continue performing the surgery without surgical tools.
“Evian. “Is the surgery very burdensome?”
“….”
“In that case, please have Evian assist you. “I don’t know if it would be better to ask Seolhwa to go first.”
“But… isn’t Miss Jeong an internal medicine doctor?”
“He is an internist, but he also specializes in cardiology, not just colonoscopy. He uses his hands just as well as a surgeon. “Just because it’s an internal medicine department doesn’t mean it doesn’t perform surgical procedures at all.”
Evian remained silent at his suggestion.
Was it a matter of pride for a surgeon to give up his assistant position to an internist?
“…If it’s more convenient, I’ll do it.”
“yes. please.”
While they were talking, Jeong Seol-hwa returned to the ambulance, out of breath.
“The nurse in the central supply room says this is the last surgical tool. “They said the rest were being disinfected.”
“This is enough. By the way, Seolhwa, you come first. “I think it would be more comfortable with you than with Evian.”
“Evian. Are you sure it’s okay?”
Evian nodded to Jeong Seol-hwa’s question.
Eventually, the surgery resumed with the two people changing positions.
“Honestly, I thought I was going to die watching Evian. “It felt like a newborn baby had been released into the water.”
Jeong Seol-hwa, who spoke Korean secretly, handed over the chest tube.
Choi Ki-seok knew exactly what to do next.
“You should have done this a long time ago?”
“fool. Do you know that now? Don’t be too partial to your lover. “When you pamper yourself, you have to pamper yourself.”
“All right.”
Ki-Seok Choi inserted a chest tube and drained the blood accumulated in the pericardium.
Wow. Wow. Wow.
A waterfall-like sound was heard as the blood flowed into the drain.
Followed by atrial anastomosis.
Ki-Seok Choi began suturing the ruptured left atrium using 4-0 prolene. Even though he performed the surgery in a narrow space and in an uncomfortable position, his skills shined.
The pressure the suture applied to the wound was appropriate, and the knot was neatly made.
Of course, Jeong Seol-hwa’s help was also great.
Jeong Seol-hwa held the wound firmly with forceps and gave Choi Ki-seok the necessary space to move easily.
In addition, we were careful to avoid creating shadows on the surgical site.
If Evian’s assist was 5 out of 10, her assist was 10 out of 10.
Her thorough assistance accelerated the process.
‘amazing.’
Evian, who was assisting, was amazed as he watched the surgery.
With Jeong Seol-hwa taking charge of the first role, Choi Ki-seok’s work went with the flow like a fish in water.
The fact is that even the craftsmanship can vary depending on the competency of the first.
Evian was the first to realize this.
In addition, he felt ashamed of the fact that he had been holding Choi Ki-seok back all this time.
“Right atrial anastomosis completed. Next is the left atrial anastomosis. “Would you like a needle holder?”
Jeong Seol-hwa shook her head at Evian’s words.
“Please give me a stapler instead of a needle holder. This area cannot be sewn with sutures. “It’s much better to just staple it away.”
“…ah. yes.”
She stabbed the stab wound in the left atrium with the stapler Evian gave her. Afterwards, the leak was checked with saline solution, but the sutures were clean.
Follow-up treatment.
Choi Ki-seok and Jeong Seol-hwa disinfected the wound located a short distance from the heart and fixed the fractured rib.
“As expected, this is our honey. “It’s a breeze.”
“A triple board thoracic surgeon should do this.”
“By the way, should I cover the surgical site now?”
“no. “There is still work to be done.”
“This is a patient who suffered heart damage from a stab wound. “Aren’t you done once you insert the chest tube and suture the wound?”
“Miss Jeong is right. “A chest X-ray and ultrasound performed at our hospital did not reveal any other diseases other than heart damage.”
Evian took Jeong Seol-hwa’s side.
Before coming to Obeid Hospital, I talked to other doctors about their patients.
At the time, it was concluded that complete cure was possible if only the trauma to the heart could be prevented.
“In the case of chest trauma, you should always think about TBI (Traumatic Bronchial Injury).”
“TBI?”
“okay. If TBI is left untreated, tension pneumothorax or other fatal diseases may follow after surgery. Even if there were no abnormalities in the test results, it must be checked if a thoracotomy was performed.”
Choi Ki-seok examined the bronchial tubes in dragon’s eye zoom-in mode.
After some time, his index finger pointed to the patient’s right bronchial tube.
“Look here.”
“Really? “The windpipe was cut.”
“For your information, TBI occurs more often in the right bronchial tube than the left. “The right bronchus is shorter than the left bronchus and is in a less protected position.”
“I see.”
“Caesar. 4-0 prolene.”
Choi Ki-seok cut off one side of the tattered bronchial tube and anastomosed both sides of the broken bronchial tube with sutures.
“How are the patient’s vitals?”
“It’s a little lower than normal, but that’s great. “I think I just need to focus on recovery.”
“Everyone worked hard. “Now let’s cover the surgical area.”
Choi Ki-seok smiled and finished the surgery.
