NABC Chapter 33 Trying to pull this on me? You're too green!
Chapter 33 Trying to pull this on me? You're too green!
"Dr. Chen, my suggestion is to transfer to a higher-level hospital."
Dr. Lyndon Rojas, who had been quietly observing from the side, suddenly spoke up.
What seemed like a well-intentioned reminder was actually timed perfectly.
It would be easy to assume that Chen Yisen was at a loss for what to do and needed advice from this "senior" community doctor.
Or rather, guidance.
Furthermore, because he had already seized the initiative, even if Chen Yisen gave the same answer later, it would be considered as "following" his instructions.
Therefore, after saying this, Lyndon took another half step back and showed a smug expression, ready to laugh at him.
Unless Chen Yisen dares to keep the patient without referring him, otherwise...
"No, we cannot refer you."
Completely to Lyndon's surprise, Chen Yisen actually rejected his proposal outright.
This is certainly not to spite the former.
In fact, Chen Yisen had also considered the issue of referral.
But the clinic had just sent a batch of patients to Lincoln Hospital, and even if you call 911 for emergency care, you'll have to wait a while longer.
Given Jamia's condition, it would be difficult for him to hold on until the ambulance arrived, and like many critically ill patients, he might not be able to withstand the ordeal of being transferred to another hospital.
Moreover, Chen Yisen had a strange feeling.
Shanes' performance in this matter was completely different from what she had shown in the morning.
For the Dominican old man, every step was a potential pitfall; a single misstep could lead to a serious medical accident.
But this time the damage was very small.
For a patient who complains of severe pain in the hip, knee, and elbow joints, no doctor can completely refuse to administer pain relief.
Whether or not hydromorphone is administered is not the key point.
Because, based on the current situation, even tramadol, which is only slightly less effective and has a shorter duration of action, has successfully alleviated Demia's pain.
As for the problems that followed, they were clearly not caused by the pain itself.
Rather, the patient has some hidden illness that he himself may not be aware of.
So even if Jamia dies, Ethan Chen bears no responsibility.
What is Shanis after?
"Report to Lincoln Hospital that there is a critically ill patient who is difficult to transfer and needs medical equipment and personnel support." After thinking about it, Chen Yisen ultimately decided not to transfer the patient but instead requested support from a higher-level hospital.
Besides worrying that Demia would die in the bumpy ambulance ride, he also wanted to keep her within his reach.
This makes it easier to control the situation.
Fortunately, the New York City healthcare system has a less common but well-established mechanism for dealing with this situation—
Remote medical control and heavy-duty intensive care ambulance.
Most community doctors don't have the opportunity to come into contact with these things, but the original owner of this body had eaten and seen them back in Bellevue.
"What exactly do you want?" Head Nurse Zulika rarely handled such requests.
Most community doctors, when faced with difficult situations, simply throw the person into an ambulance and call it a day.
"Let me remind you first, Dr. Chen, that higher-level hospitals will absolutely not send emergency doctors. At most, they can bring equipment and personnel that can be used in the ambulance."
There is a severe shortage of emergency room doctors in any medical institution, and it is impossible for them to disrupt the normal operation of their facilities for your case.
However, hardware resources (aside from hospital beds) are not scarce for large hospitals.
Chen Yisen himself was also rapidly considering what he wanted.
Demia's symptoms mainly manifest in two ways: severe joint pain and insufficient blood oxygenation and low blood pressure.
This suggests that the problem is most likely with the red blood cells.
No matter what the specific problem is, there is always a solution that can work wonders.
"I'm preparing to perform apheresis on him, so I need a blood cell separator, a dual-pathway device, anticoagulants, and type A blood that has been depleted of white blood cells, is negative for cytomegalovirus, positive for Rh, and matched for C, E, and K antibodies..."
Apheresis, simply put, involves removing the patient's problematic red blood cells and replacing them with normal red blood cells.
It can improve blood circulation without increasing the burden on the heart.
During his previous high-altitude training, Chen Yisen had learned about cases of treating polycythemia complicated by arterial thrombosis using apheresis.
In some ways, this technology actually fits Amber Zheng's fantasy about "blood transfusion".
However, most people have never even heard of it, let alone come into contact with it.
In fact, even Zulika, who had been a nurse for half her life, was stunned:
"What are you doing?"
Chen Yisen had anticipated this situation, so he wrote out the application form in traditional Chinese characters while speaking.
"RBC Exchange, just tell them that, they'll understand what I mean... Oh, and tell them to avoid blood from Octapamma Plasma if possible, and we'll prepare some calcium gluconate on our side."
Although various blood product companies may be in cahoots, the fact that Octopus was chosen by both Amber Zheng and Omar suggests that it is the most outrageous among its unscrupulous peers.
If you can avoid it, try to avoid it.
Zulika took the application form and went to the side to make a phone call.
Shanis volunteered to fetch the medicine.
But Chen Yisen stopped him.
It's easier to keep her in sight.
But the crisis was not over.
No matter how effective apheresis is, the first priority is to keep Demia alive until support arrives.
"Dr. Chen!" Andrew's voice preceded his arrival, "The blood test results are in!"
He then handed the report to Chen Yisen.
The latter immediately looked at the data he was most interested in:
Total hemoglobin: 133g/L
Hematocrit: 40%
?
That's ridiculous, everything's normal.
Then look at the other results.
White blood cell count (WBC): 18.5 × 10⁹/L
Too high.
This indicates a severe stress response or latent infection in the body.
Platelet count (PLT): 450 × 10⁹/L
Similarly, the levels are too high.
This means that the blood is in an abnormal hypercoagulable state.
Lactic acid (Lac): 3.8 mmol/L.
The anaerobic metabolism is intense, and the oxygen supply capacity is indeed insufficient, but fortunately it has not reached a very serious level.
So, the most likely answer is...
"Dr. Chen," Lin Deng's cheeky voice rang out again from not far behind, "the patient's condition is not optimistic. The effects of tramadol are starting to wear off. Referral is the most responsible thing to do..."
Although his tone was a bit outrageous, what he said was true.
Jamia was once again covered in sweat and clenched his teeth, clearly beginning to endure excruciating pain again, but because he was not in a state of consciousness, he could not express it as he had before.
"Cough cough—" As he spoke, Jamia suddenly coughed violently again.
"Shut up!" Chen Yisen had basically determined the patient's problem, so he directly and sternly shouted at Lin Deng, "All you know is to transfer patients when something happens. Do you think you can conjure up an ambulance right in front of you?"
Lyndon fell silent.
"Since you can't conjure it up, Dr. Rojas, are you suggesting we just leave the patient here to die?"
"I……"
Dr. Chen immediately labeled Linden as "indifferent to the patient's life or death," then ignored him and began issuing instructions:
"Nisi, switch the oxygen tubing to a non-repeating breathing mask and administer pure oxygen at 15L/min."
"Andrew, prepare saline solution and a pressure infusion bag, administer a rapid drip at 800ml/hour."
"Head Nurse, give him an intravenous injection of 30mg of ketotropic acid..."
The three of them got back to work in an orderly fashion.
Lyndon tried to continue his performance: "Ketoroxygenase is an anti-inflammatory drug, it's not suitable for his condition..."
Chen Yisen now really hopes that this person is simply bad.
Otherwise, the average level of these community doctors would be truly disheartening.
"Dr. Rojas, listen carefully, I'll only explain once." Chen Yisen said, slamming the blood test report onto a small table in front of Rojas: "The patient's red blood cell count, apparent blood oxygen level, and hemoglobin content are all normal, but there is a significant lack of oxygen supply, indicating that the red blood cells can transport oxygen, but they are stuck in the blood vessels, so sickle cell disease (SCD) is highly suspected."
After saying that, he pointed to Demia, whose facial features were almost contorted in pain: "The pain caused by sickle cell disease is essentially aseptic inflammation plus ischemia, so nonsteroidal anti-inflammatory drugs combined with opioids are far more effective than using high-dose painkillers alone... and cause less damage to the patient's body."
In fact, Chen Yisen was 100% certain of his conclusion.
After having the hypothesis of sickle cell disease, he changed the detection target of electrical impedance tomography from the joint to the upper left abdomen.
This ability, of course, cannot detect the morphology of cells within blood vessels, but it can significantly alter the impedance of one organ—
spleen.
Demia's spleen had almost completely formed a fibrotic, high-resistance scar area—a characteristic splenectomy phenomenon in SCD patients.
Based on the previous physical examination and test results, there are basically no other possibilities.
Seemingly to verify Chen Yisen's statement, Head Nurse Zulika also administered a ketorolac injection to Demia at this time.
The effect was almost immediate.
The pained expression on Demia's face gradually disappeared. Combined with the high-flow-rate pure oxygen input and the rapid impact of large doses of saline, her previously precarious heart rate and blood pressure gradually returned to a safe range.
Andrew noticed that Jamia's eyes suddenly moved.
"The patient has regained consciousness!"
Chen Yisen remained remarkably calm: "We're far from out of danger; we've only slowed the rate at which the situation is deteriorating."
Then he looked at Andrew and said, "Andrew, keep an eye on the patient's heart rate. If it starts to rise again, reduce the infusion rate to 150 ml/hour and continue that rate."
"it is good."
Andrew quickly ran to the other side and stood guard next to the heart rate monitoring equipment.
Chen Yisen listened to the patient's lungs again and breathed a sigh of relief after confirming there were no moist rales.
The absence of pulmonary edema indicates that the problem is not serious in the short term.
Then, he said to the crowd meaningfully, "Now, we can wait for the ambulance to bring backup."
Head Nurse Zulika had just gone out to get medicine and hadn't heard Chen Yisen's analysis.
Therefore, I could only instinctively exclaim, "That's amazing... thank goodness I didn't just wait around..."
But this unintentional comment dealt Lyndon a devastating blow.
While one's own failure is regrettable, the success of one's opponent is even more worrying.
The momentary impulse to take credit now seems like a self-inflicted wound.
Chen Yisen glanced at the test data, then slowly walked up to Linden and gently patted him on the shoulder.
First, in a low voice, but loud enough for everyone in the room, including the patients, to hear:
"Dr. Rojas, instead of spending your days figuring out how to take advantage of your colleagues, you should spend more time thinking about how to treat your patients better."
Now, even the other patients in the observation room were giving Linden strange looks.
Then, they switched to a soft voice that only the two of them could hear, a voice that even the recording equipment couldn't pick up:
"Trying to pull this on me, Dr. Rojas? You're still too green..."