28 Polite to Annoyed (1/2)
After the radiographer was done. Li Xiuying looked at the images, 3 broken ribs on the left.
The ribs just need to be wrapped, and analgesia to manage the pain.
Li Xiuying checked the monitors and re-examined Xǔ Luli.
Li Xiuying: ”Vital obs improving, breathing normal. 3rd year, the has numerous cuts over the left hand side of her body, Clean each laceration and ensure there is no glass or debris and dress the wounds. The patient will need antibiotics. D place a catheter and continue to monitor her, assist the 3rd. I want a full body CT to check if she had any other injuries we've missed.”
Li Xiuying moved to stand beside Xǔ Enlai.
Li Xiuying: ”E, F and Xǔ Enlai's 3rd year. Report on patient status.”
Xǔ Enlai's 3rd year resident: ”The patient is conscious and responsive to speech, he is breathing normally, respiratory rate of 14, normal breath sounds, Capillary refill <2 seconds, pulse 86 normal rate, rhythm and strong. Normal heart sounds, no murmurs. Pupils are equal in size and reactive to light, blood glucose is 7 mmol/L, Left arm dislocation and what appears to be a broken right Tibia. The patient's obs are stable.”
Li Xiuying: ”Plan”
Xǔ Enlai's 3rd Year resident: ”We have started administering IV fluids, and 1 gram of IV paracetamol. We have given the patient a dose of morphine sulfate. We have sent off bloods and will continue to assess the patient's status. We have bleeped the orthopedic team and they are sending someone down. A theater has been booked.”
Li Xiuying: ”You need to X-ray the patient's leg. How long for the orthopedic team? When did you call?”
Xǔ Enlai's 3rd year: ”5 minutes. Called them at 7:10 pm.”
Li Xiuying: ”Fine.”
She approached Xǔ Enlai.
Li Xiuying: ”I'm Dr. Li, can you tell me your name?”
Xǔ Enlai groaned in pain: ” Arrrgghhhhh, Xu Enlai, it hurts, it hurtsss!”
Li Xiuying immediately went to assess Xǔ Enlai's right leg.
Suspected compartment syndrome, the fracture also appeared unstable and the right leg is significantly shortened compared to the left.
Li Xiuying: ”Can you describe the pain?”
Xǔ Enlai: ”It hurts so bad and it feels like my skin is burning.”
Li Xiuying turned to the 3rd year: ”Where are the orthopedics team? It's been 6 minutes at 42 seconds.”
Li Xiuying: ”E and Xǔ Enlai's 3rd year get an X-ray of Xǔ Enlai leg then take him to theater. I'll need to carry out an emergency fasciotomy and repair the broken tibia. You have 15 minutes.”
Li Xiuying stepped over to Xǔ Enlai's left arm.
It's clearly dislocated.
Xǔ Enlai groaned again: ”argghhhhhh!”
Li Xiuying positioned Xǔ Enlai in a sitting position. She bent his arm at the elbow, arm pointing forward. She held his upper arm to his body and twisted his arm outwards so it formed an L, then she pulled his upper arm anteriorly by 5.5 cm and rotated Xǔ Enlai's lower arm to lie across his body.
Shoulder back in place.
Li Xiuying: ”Xǔ Enlai, did you hurt your head in anyway?”
Xǔ Enlai: ”aarrrghhh noooo.”
Li Xiuying: ”I need to carryout an emergency surgical procedure called a fasciotomy. You have a build up of pressure in your right leg which if left for more than 6 hours could result in you loosing your leg. I'll be putting lateral incisions in your leg with a scalpel. I will also be inserting screws and a plate to end your tibia, depending on the extent and type of fracture. You will first need to get an X-ray.”
Xǔ Enlai: ”Just make the pain and burning stop.”
The orthopedic consult came running in.
Orthopedic consult was gasping for breath: ”I'm sorry, I'm late I was with a patient.”
Li Xiuying raised an eyebrow. ”What year of specialty training?”
Orthopedic consult: ”4th”
Li Xiuying headed towards Xǔ Junjie: ”One patient left to assess.”
Xǔ Junjie was talking quietly with Ren Longwei beside him about the accident. He knew it had to be a planned hit.
Who would be stupid enough?
When Li Xiuying approached Xǔ Junjie, she noticed that he didn't seem to be in any pain at all.