episode_0063

Episode 63. Monster Hunting Festival (3)

****

Alain, a healer affiliated with the Academy.

The eldest of the graduate students of Professor Fisher, Dean of the Department of Healing and a healer. He was one of the people in charge of this event. He had many worries, but… … .

This time, there’s that professor, right?

A professor who cured all the fools who tried to kill each other during a swordsmanship competition. Not a single one died or was injured beyond recovery.

I heard that he was a physician at the royal court and has recently taken up a new post. It seems that his skills are truly certain.

The instructions that came down from the dean’s office were as follows.

Send any patient who seems to have even the slightest problem to Professor Asterix. Send any patient who seems to have no major problems to him as well.

Alain, who was on the scene, did so.

I hope this time it goes smoothly without anyone getting hurt, but the knight we just sent seems to have been injured rather seriously… … .

Let’s believe it for now. There’s no other way. Alain stamped his feet impatiently in front of Professor Asterix’s ward.

That student. Will he be able to survive?

****

This patient will die if this continues.

Oh, my head hurts. If I leave it alone, the blood flow to my head will stop and I’ll die. If I put epinephrine in to raise my blood pressure, my extremities could die.

No matter how much I thought about it, this seemed like the only way. I sighed and picked up the scalpel again.

“There’s no time. Hold on tight.”

“No, wait a minute. Doctor-”

The patient muttered something with a shocked expression, and Istina waved her hand out of the corner of my eye. Why this time?

“Professor. Are you really not going to use anesthesia?”

“Hey. I don’t have time right now, so I’ll put the blanket in your mouth. It won’t hurt too much. ”

That’s because I can’t give you anesthesia.

I didn’t stop my hands as I spoke.

Lidocaine, a local anesthetic, can also act as a vasoconstrictor, although it is not recommended to administer more.

“You said your heart was open. How could it not hurt-”

“Istina. Be quiet.”

Istina kept her mouth shut. I would like to explain, but there is no time right now.

I very carefully placed the mass into the patient’s left fourth intercostal space.

The window doesn’t have to be big at all.

2 centimeters should be enough.

The muscles between the ribs are thin, made up of three layers, each a few millimeters thick.

After a while.

The pericardium was revealed through a small wound. The patient flinched, but did not feel much pain. The pericardium was now visible.

There is no risk of hitting other structures.

Just drain the liquid slowly.

“It’s all done now. Just hold on.”

“Ugh… … .”

The patient squinted, but didn’t move or scream. Although pericardiocentesis is a risky procedure, it shouldn’t hurt much.

I grabbed a piece of the pericardium with forceps and stuck the needle into it. A reddish-brown liquid mixed with blood began to fill the syringe.

The effects will be immediate.

Compared to all the fuss so far, the process of treating cardiac tamponade itself is not a big deal. It’s just a matter of removing the fluid with a needle.

The hole I made between my ribs was the size of a fingernail.

The wound on the pericardium was also a needle hole. It was a difficult procedure due to the risk of touching the area around the heart, rather than the complexity of the actual procedure.

“All done. Now let’s sew it up.”

A few minutes later.

Miss Eleanor sat upright in her sickbed. She had a nauseous look on her face. She had retched and coughed a few times, but… … .

Alive.

“Oh.”

“How are you feeling, patient?”

Still, his pale complexion has improved. He seems to be breathing properly again.

“Ugh. My heart is still pounding… … .”

“Because the knife touched the pericardium.”

“Are you okay now?”

“The procedure itself went well. I think it will be fine in a day or two.”

If your blood pressure is stable, you can continue living as is. If your blood pressure is not stable even after doing this, well, then there is no solution.

You have to drain the water from the pericardium repeatedly so that the heart can beat. If you do that, you die, and if you get better, you get better.

“Do I have to sit down?”

“Yes. You shouldn’t have water in your lungs.”

You shouldn’t lie down because your lungs are filled with fluid. If you lie down, you may have trouble breathing again because of the fluid in your lungs.

The reason is a bit complicated. The water in your lungs also flows in the direction of gravity, and when you lie down, the water spreads out and the surface area it occupies increases.

The hydrostatic pressure created by the height of the lungs also prevents the exudate from coming out, and so on.

I was worried because it was a high-risk procedure that required puncturing the pericardium with a needle and draining pericardial fluid.

The operation was successful and the knight is alive.

I handed Eleanor a blanket. The knight was still sitting there with a grumpy expression.

Well, it would be absurd to expect someone to feel good after stabbing them in the heart with a needle. But I still saved them, so it’s a bit disappointing.

“Give me your hand. I’ll hold your Mac again.”

“I don’t like it. Thank you for saving my life, but.”

“No… ….”

Eleanor wrapped the blanket around herself and folded her hands on her knees, somewhat defensively. Yeah… . . . I guess that could be true.

The man here looked at me.

The look on his face was still full of distrust.

“But, what did you do?”

“There is a sac called the pericardium that surrounds the heart, and it was surgically removed because it had too much fluid in it. If there is too much fluid in the pericardium, it puts pressure on the heart.”

Eleanor tilted her head again.

“Heart surgery?”

“It didn’t reach the heart.”

“I see. Why is the liquid cold?”

“It’s due to trauma. It could be damage to the coronary artery or a large blood vessel, or it could be damage to another blood vessel. There’s no way to know right now.”

I’m still hoping that it will be okay.

As the pulse and color have returned, there is a possibility that the bleeding inside the pericardium has stopped. From here, it can be resolved with medication alone.

There is no solution beyond this.

“Anyway, the procedure went well. If your blood pressure and pulse are stable, there will be no problem. We will monitor for sepsis, and since the pericardium was opened, we will administer preventive antibiotics.”

Eleanor nodded slowly.

“What if it’s unstable?”

“If that happens, there is no solution. We will respond to the symptoms for as long as possible and help you recover.”

“You’re being honest. Okay. ”

Eleanor was a person who asked a lot of questions.

Usually, people don’t ask this many questions right after a procedure, even if they are sick or tired.

“You will be hospitalized in the ward for several days and will need to take medication. You may have difficulty breathing, so please sit down. You never know when the water in your lungs will drain.”

If the heart rate continues to rise, beta-blockers can be used, and if pleural effusion or pulmonary effusion continues, loop diuretics can be considered.

This needs to be monitored.

The prophylactic antibiotic we will use is ampicillin.

But, if endocarditis or sepsis develops properly, ampicillin won’t be enough.

We’ll need a much stronger antibiotic than that… … Well, let’s think about it when we get there. I placed the vial next to the hospital bed.

“Take one tablet every morning.”

“What kind of medicine is it?”

You shouldn’t think, “A person who couldn’t even control his temper a little while ago is now talking a lot… ” A few days ago, I saw a drug addict.

“It is a drug that kills bacteria. Since the patient had the pericardium opened, he is at high risk for bacteremia, so we will prescribe the drug as a preventive measure.”

Eleanor looked at the vial for a moment and nodded. I hope that was a little convincing.

“When will you be discharged?”

“Just wait three days. If there are no problems for three days, you can probably be discharged.”

“Thank you.”

“Get some rest. Oh, sit down! ”

I grabbed Eleanor as she tried to lie back down.

No, I told you to sit down. They say if you lie down and sleep now, you might have trouble breathing.

Let’s just assume that he’s still in a state of shock. The knight’s treatment is over.

I took Istina out of the ward.

****

You’ve worked hard for a long time.

The monster hunting season should be over by now. We’re back in the lab, sitting at our desks. It’s been a long day.

“Did you keep a patient record?”

“Yes.”

Istina nodded.

“I think a lot of people get hurt for stupid reasons. I thought most people get hurt while fighting.”

“Okay.”

Working in the emergency room, you don’t get surprised when a patient does something, but it was a bit surprising that he ate mushrooms and collapsed on his own.

What’s going on in that guy’s head?

Istina was sitting hunched over on the sofa, perhaps tired, and looking at the distant mountains.

Right. I didn’t say that.

“Istina. You know the knight teacher from earlier?”

“Oh, yep.”

“If your body temperature goes over 38 degrees, your heart rate goes over 90, or your respiratory rate goes over 20, let me know. You need to be careful because you are at high risk for sepsis.”

A moment of silence. Istina hesitated for a moment, then tilted her head as if she didn’t know.

“What is sepsis?”

“Bacteria circulating in the blood.”

It is the king of internal medicine diseases.

“Okay, but if your body temperature is 38, your heart rate is 90, and your respiratory rate is 20, is that sepsis?”

It’s a complicated issue, but that’s roughly it.

I nodded.

“Please explain in detail.”

Maybe because she was tired, Istina sat with her legs crossed and thought for a while. Then she wiped her glasses and turned her head towards me.