27 Only 24 Hours (2/2)
Xǔ Junjie ”Look at them first! Luli! Enlai!”
Ren Longwei: ”Junjie that's Dr. Li, Luli and Enlai will be okay.” Ren Longwei indicated towards Li Xiuying.
Xǔ Junjie quietened down and stared at Li Xiuying
It will be alright if it's Dr. Li.
Paramedic: ”Xǔ Luli 19 year old female front passenger seat, unconscious. She appears to have numerous fractures and lacerations.
Xǔ Enlai 18 year old male, was in the backseat driver's side, dislocated left arm, broken right leg.”
Li Xiuying: ”Where are all the doctors here?”
She looked around and saw 6 first year residents, and three 3rd year residents. There were also nurses and healthcare assistants.
Li Xiuying: ”One 3rd year resident with each of the patients, do an assessment and stabilize. I will then come and reassess. From left to right you are all A,B,C,D,E,F. AB with Xǔ Junjie, CD, with Xǔ Luli and EF with Xǔ Enlai. One of you need's to establish peripheral venous access, 2 cannula's if possible I'll need a set of bloods. Someone get me a set of obs on all the patients, repeat every 5 minutes. All the patients need morphine, a bag of IV fluid and a re-breath mask with 15 L oxygen.”
Li Xiuying rushed over to Xǔ Luli.
Li Xiuying: ”Get me a radiographer; I need an emergency X-ray of the chest and abdomen for Xǔ Luli. Someone go and book me three operating theaters. ”
Li Xiuying ”3rd year report on Xǔ Luli.”
Xǔ Luli's 3rd year: ”Decreased respiratory rate of 7, no signs of...”
He was nervous and his palms were sweating.
Li Xiuying: ”Stop talking; get me a chest drain now.”
Li Xiuying grabbed a stethoscope and listened to Xǔ Luli's chest. There were no breath sounds on the right hand side. She felt the patient neck and found that the windpipe was deviated. Li Xiuying checked the monitor's; patient had increased breathing rate, high heart rate and low blood pressure. She listened to the Xǔ Luli's heart; the heart sounds were quiet.
Li Xiuying: ”D Bring me the echocardiogram or an ultrasound machine. 3rd year get a Pericardiocentesis kit, a nasogastric tube kit and 6 ampoules of Lidocaine 1%. Someone get 3 sets of sterile gloves size 6, sterile drapes and chlorhexidine solution.”
A nurse came forward and pushed a trolley containing the items Li Xiuying had asked for. The 3rd year resident and D had also returned with the kit and echocardiogram machine.
Li Xiuying was grabbing items as she asked: ”D, Xǔ Luli's 3rd year. What is beck triad?”
D: ”Hypotension, increased venous return and quiet heart.”
Li Xiuying: ”3rd year what am I worried about.”
Xǔ Luli's 3rd year: ”Pericardial effusion.”
Li Xiuying: ”First the insertion of a chest drain for her tension pneumothorax, then I'll drain the fluid around the heart.”
Li Xiuying completely tore off Xǔ Luli's top and sterilized Xǔ Luli's entire chest. She injected lidocaine around the 4th and 5th intercostal space then used a scalpel to make an incision between the two ribs. She proceeded to insert the chest drain and secured it in place. She listened to the chest.
Breath sounds improving.
Li Xiuying then positioned Xǔ Luli bed at 45 degrees. She inserted a nasogastric tube first.
She used the echocardiogram machine to confirm the presence of the effusion around the heart. She made a small scalpel incision approximately 8.5 cm from the sternum between the left 5th and 6th rib. Li Xiuying then inserted a needle connected to a 60 ml syringe containing 5 ml of saline; she maintained a 45 degree angle. Li Xiuying advanced for exactly 5 cm ; fluid immediately started filling the syringe. When the needle filled she stabilised the needle and replaced the syringe with an empty one. The 2nd syringe filled half way and stopped. Li Xiuying removed the needle.
The radiographer finally arrived and was shocked to see a chest drain in place.
Radiographer; ”Dr. Li you are not meant to insert...”
Li Xiuying deadpanned: ”If I waited for you, the patient would be dead now.”
The radiographer shut his mouth and took an X-ray of Xǔ Luli's chest and abdomen.
Li Xiuying sighed.
If I only had 24 hrs I would not be here.