episode_0062

Episode 62. Monster Hunting Festival (2)

****

Gastric lavage and administration of atropine.

“Uwueek. Ugh. Ughhh.”

The wizard who had been lying down until just now sat up on the hospital bed and retched for a while. Istina used healing magic on the patient.

“Are you feeling better?”

“No.”

This world is good. Thanks to healing magic, recovery is very fast. If it weren’t for the healing magic of the healer who accompanied me earlier, this patient would have died from respiratory distress a long time ago.

“I’m just curious. Why did you eat the mushrooms?”

“Ugh. There’s something that you can eat to replenish your mana, but I don’t know if I ate too much or if it was a different type. Anyway… … . Thank you.”

“Does that mean you can just pick up any mushroom on the street and eat it? If it weren’t for me, you might really be dead, teacher.”

“Yes… … .”

Inati lowered her head. There is something that comes to mind when working in a hospital. You should never underestimate people.

There are all kinds of crazy people out there. It’s like picking up mushrooms on the street and eating them because you’re bored.

Like when a cucumber breaks while you’re using it and you can’t get it out, so you end up in the emergency room in a daze.

Let’s not think about it in detail.

Never underestimate ordinary people. Just because I don’t pick up strange mushrooms while walking through the forest, don’t expect other people to have the same common sense.

****

Anyway, Mr. Mushroom returned alive. Didn’t he learn the lesson that you shouldn’t pick up and eat nameless mushrooms in the forest?

“There are fewer patients than expected?”

“I don’t know. I guess the monsters are fighting quietly.”

I thought there would be a lot of trauma patients.

With so many people out hunting monsters, there must be some who get hurt. There are a lot of people who come back with strange injuries, and the ones who actually get hurt while fighting monsters-

Ah. Now I see it.

“Oh, as soon as I said that, a stretcher came.”

“Istina… … . Don’t say that you don’t have any patients. Just think about it inside.”

“Yes.”

The goddess of fate never gives in to provocation. The sick can come at any time, so let us enjoy the moments when no one is sick.

The first patient to come in was a patient who passed out after eating mushrooms alone, so it was a bit disappointing. This time, the patient who came in was a trauma patient.

I ran with Istina.

“Patient information.”

“Academy student, Ms. Eleanor. She is unconscious and has a contusion on her left rib cage! Her left rib is broken and her pulse is weak!”

“Where are you hurt?”

“Bear!”

No further explanation was needed.

But do bears count as monsters? Is there a reason to get hurt fighting a wild animal that isn’t even a monster? That’s not important right now.

Let’s see. A laceration to the side, a bruise on the chest.

I feel like something big is going on? I can’t get my pulse going. I’m breathing, but my face is pale.

I tried to feel the pulse again. I couldn’t feel the pulse at my wrist… I tried feeling the pulse at the nape of the patient’s neck again.

It’s not that there isn’t any. Rather, it’s fast. Low blood pressure, and a slight tachycardia. This is-

I turned my head to Istina.

“This is a hemodynamically unstable patient. Get out of the operating room and call the nurse! And bring a stethoscope!”

Cyanosis, low blood pressure and tachycardia. You might think it’s simply due to bleeding, but there are many problems that can arise from trauma.

A perforated lung caused by a broken rib? Intrathoracic bleeding? There are more than a few possible causes, and not many of them can be solved.

There is just one thing that is fortunate.

It didn’t seem like any internal organs were injured, because there were no bruises on the abdomen this time.

First, I restored the blood pressure. I took out the epinephrine syringe and injected it into the vein in the patient’s arm.

Epinephrine is a vasoconstrictor.

When epinephrine is injected intravenously, it causes the blood vessels throughout the body to constrict, slightly increasing blood pressure. It can also reduce any internal bleeding that may occur.

Although I haven’t been able to catch my pulse, I feel like I’ve regained some consciousness. Could it be that the injection of epinephrine has caused a relative surge of blood to flow to the brain?

Still, the epinephrine seemed to be working, and I hooked up the IV to the patient’s arm. I hope that will help maintain his blood pressure.

Let’s wait a few minutes and wake him up.

“Patient! Wake up! I’m going to palpate the injured area now, so if it hurts, answer!”

“Oh, it hurts even when I stay still-”

“Promotes.”

“Eww! It hurts!”

They said he was unconscious, but he’s fine.

As I said last time, if you fall asleep in a situation where you suspect you are bleeding, you may end up having to cross the Jordan River. You have to wake them up forcibly.

“Eww!”

Miss Eleanor… … . Your voice is good. However, apart from the certainty of your reaction, your complexion was becoming increasingly pale. Your pulse was also weakening.

“Stethoscope!”

What’s taking so long? I hastily snatched the stethoscope from Istina’s hands.

We need to check if the heart is beating abnormally due to trauma, or if there is blood in the chest cavity or lungs. If only there was an electrocardiogram machine, we could have diagnosed it earlier.

“I will check your blood pressure.”

I frowned.

Let’s think about it a little more. When blood fills the lungs, it makes a sound like phlegm boiling, or a crackling sound. It’s a sound that occurs when fluid fills the lungs.

If fluid builds up in the rib cage outside the lungs, the lungs move around due to the water, rubbing against the pleura, causing a strange friction sound.

First of all, it didn’t seem like there was water in his lungs.

Breath sounds are normal. There was no evidence of intrathoracic bleeding or fluid in the lung parenchyma.

Finally, the heart, the flower of the stethoscope.

I can hear my heartbeat, but it’s fast and somewhat dull. And, more importantly… … I can hear a friction noise coming from my heart.

There is bleeding in the pericardium, which is compressing the heart and preventing the heart from functioning properly. It is not something that can be confirmed by auscultation alone, but this is the conclusion I have reached.

“There’s a problem with your heart.”

Istina looked at me.

“Are you going to have surgery?”

“Just think about it for a moment.”

Thoracic surgery is one of the most difficult surgeries. Even if I were to open this patient’s rib cage and operate on it, the chances of this patient surviving the surgery would be… well… not very high.

Even if there is a problem with the heart, it doesn’t seem like something I can fix. At least not surgically. So what can I do?

It’s not like there’s no way to treat cardiac tamponade. You can do that by opening the pericardium.

Cardiac tamponade is a condition that occurs when the heart is compressed. Naturally, when the fluid in the pericardium fills up and presses on the heart, various problems occur.

As pulmonary circulation deteriorates, fluid begins to build up in the lungs and arterial blood pressure drops.

The cause of the heart compression is the problem. If it is a coronary artery or a large blood vessel, there is nothing that can be done, but the fluid that is pressing on the pericardium can be removed.

If there was an ultrasound machine, I could just use a needle, but since there is no ultrasound machine here, there is no option to just insert a needle, and I have to do the procedure while looking at it with my eyes. It won’t be easy, but…

“We can’t find any surgical preparation for bleeding. We’ll make an incision in the patient’s pericardium and drain the fluid that’s pressing on the heart. Get ready for surgery.”

Istina nodded.

****

It’s urgent. It didn’t take 2 minutes to prepare for surgery. I had been preparing for a while.

“Location.”

Pericardiocentesis.

This is a surgery that can be done with just a needle. You just need to insert a syringe into the pericardium and drain the blood that fills the pericardium.

The problem is that this process usually involves ultrasound. Without ultrasound, you can’t put a needle in the pericardium to remove the fluid.

If you insert a needle without ultrasound, you could puncture the pericardium and potentially puncture the heart.

Then what… … . It’s death.

“I’m going to make an incision between the ribs now. I’m going to make an incision between the ribs to expose the pericardium, and I’m going to open it while looking at it with my eyes.”

“Then can I live?”

“Maybe.”

Istina frowned.

The patient looked up at me with a terrified expression. I felt a little sorry for him.

“Do I have to have surgery? I feel fine now, but if I just lie down for a bit-”

“It’s because of the drug effect. I’ll die soon.”

“Are you dying?”

“If you don’t have surgery.”

The patient’s hands are already blue.

One of the side effects of epinephrine. If peripheral blood vessels constrict on top of already low blood pressure, blood circulation to the extremities may be cut off.

It’s better than not getting blood to the brain at all, but if it’s not fixed within a few hours, my fingers and toes will die. I can’t just leave it like this without draining the pericardial fluid.

The feeling that your current condition is relatively normal is just an illusion created by the effects of the drug.

“Can’t I use anesthesia?”

“No anesthesia required.”

First of all, there is no time to anesthetize. I don’t know what might happen if I anesthetize the area near the heart right now.

“You said your heart was open – Knock knock, knock.”

It was a deep cough. Even without a stethoscope, I could feel water filling up the lungs.

“This is the sound of a cough with water in the lungs… … . We will proceed with the procedure right away.”

The goal is to not touch the heart. This is a situation where only the pericardium must be delicately opened.

More importantly, did this patient also injure his lungs while fighting? Or did his lungs start to fill with effusion due to the worsening symptoms of cardiac tamponade?

Either way, there was no time to waste. I couldn’t close my eyes tightly… …! I opened them as wide as I could. The surgery was going to be a success.