Great Doctor Ling Ran Chapter 256
256 Legendary Level
"Have you done the arterial blood gas test? Are the results out yet?"
"Control the blood pressure and heart rate."
"How about the CT scan report? Let me know when the result is out."
"See if it is possible to use the autologous-blood recovery machine."
Huo Congjun was the main person in charge of the Emergency Department. He did not solve the problems regarding what types of medication should be used and how much the dosage should be. Of course, he paid attention to the prescription plan and the ways they should administer the medication when they were suggested by the doctors, and he would not make any comments if there was not anything wrong.
What Huo Congjun cared about was the resuscitation speed and the overall plan.
Resuscitations had their own procedures.
The arterial blood gas test and other check-ups like CT scans would take some time before the report was out. If they were not arranged any sooner, the subsequent procedures would be delayed. The doctors' perspective was like X-ray eyes. A good doctor would be able to understand most of the patient's body from a CT scan. Problems such as internal hemorrhaging could be seen clearly using devices such as the CT scan.
What they needed to do was to manage their time well.
At the same time, if an autologous blood transfusion was required, the time for the autologous-blood recovery machine to be arranged into the treatment schedule had to be ascertained.
Huo Congjun was the advocate for autologous blood transfusion from Yun Hua to Changxi Province. There was a meaning behind why he was given that title. It meant that Huo Congjun knew autologous blood transfusions very well, and it showed that the Emergency Department of Yun Hua Hospital was equipped with a complete set of relevant devices.
When the patient was in the ambulance and later the helicopter, the emergency treatment team did not have the facilities to administer an autologous blood transfusion. If they infused hundreds of blood products into the patient after they reached the hospital, there would be a lot of trouble in the patient's prognosis. Naturally, autologous blood transfusions did not reduce a lot of problems, but at least the hospital did not need to worry about running out of blood products.
However, there were more requirements to administer an autologous blood transfusion. One of the requirements was the device itself. The autologous-blood recovery machine would collect the blood and cleanse the blood with some simple filtrations. Then, when it was transfused back to the patient's body, the level of blood contamination needed to be taken care of.
Huo Congjun was busy the tasks related to autologous blood transfusion. At the same time, he kept giving away authorization to the emergency treatment.
When Zhao Leyi performed the exploratory laparotomy, he removed a great number of blood clots.
Department Associate Du performed the treatment himself. He separated every ligament in the spleen step by step until the pedicle of the spleen was shown. After he performed a double ligation, he removed the spleen.
Doctor Zhou sutured the even tear that was 0.78 inches in length on the left side of the liver. Then, he used a large gauze pad to press on the slit on the diaphragm.
Attending Physician Zuo Liangcai handled the femoral vein alone.
Once they did these steps, the golden hour passed. The doctors around the operating table were exhausted.
The doctors could stay for longer stretches of time in the operating theaters. But in the process of resuscitation, it was the position that made the doctors suffer.
Take Ling Ran as an example, he had to straddle the gurney. He knelt on one knee while his other leg was curled up. His hands were either used to stop the bleeding, or for him to work as a part-time assistant. Ever since Zhao Leyi stepped on the footstool, he had never left. Even Huo Congjun merely stood by the gurney to give instructions. Doctor Zhou came earlier, so there was a robotic arm on his right, which allowed him to have a bigger space.
However, regardless of whether the space for each person was bigger or smaller, everyone stood as if they were being penalized.
They could still continue even if they had been made to stand for an hour, but their fatigue was showing.
Huo Congjun could not give them time to rest. He sighed and talked to Ling Ran, "Explore the lungs with your hands to detect if there's any rupture. If there's no rupture, we'll inflate the lungs and suture the diaphragm."
The last sentence he said was meant for the anesthetist.
The anesthetist agreed and immediately started his work.
Doctor Zhou asked for a 7-0 surgical silk suture and waited silently for Ling Ran's reply.
Detecting problems with the hands was a common practice among surgeons. When Huo Congjun was young, it was considered as a basic operation for him. All the doctors in the room knew how to do this, including Doctor Zhou.
But now, Huo Congjun was more confident in Ling Ran's skills with his bare hands.
The other doctors did not express any disagreement with the decision. These doctors had no problem in finding a tear, but it would take them a longer time to ensure that there was no rupture. No one was more confident than Ling Ran.
Ling Ran was still quite new in Yun Hua Hospital, and he had not mastered many surgery skills yet. But his ability in specific skills was seen and recognized by many doctors.
Normal doctors knew how to do things like stopping the bleeding with their bare hands. But if they were asked to do it like Ling Ran, especially without setting up a surgical field, they would not be confident in it.
Detecting injuries with your bare hands was not as simple as other people thought. Human lungs were not entirely smooth, and different lung surfaces would have different textures. Detecting a lung rupture with bare hands alone was like guessing the type of the Mahjong tiles by touching its surface using the hands alone. Both required specific training to know what was on the surface.
In order to ensure high accuracy, a comparable level of skill was required.
However, since Ling Ran could perform barehanded bleeding control, he knew the organization of ruptured tissues very well.
He quickly checked through the lung, and repeated his examination before he said, "No rupture found." Huo Congjun then gave his instruction without any doubt toward Ling Ran's judgment, "Put in the drainage tube. Inflate the lungs."
When the lungs of the patient were inflated, the diaphragm, which had pressure applied on it for bleeding control, was completely exposed. Doctor Zhou went up to the operating table again, and he used the 7-0 surgical silk suture to perform a simple interrupted suture the diaphragm.
Huo Congjun felt slightly relieved. Now, the bleeding of the liver and spleen, as well as the chest, were under control. These organs were supplied the most blood in the human body, right after the heart.
Huo Congjun then thought about something else. While he waited for the chest drainage to be completed, he said, "Suture bones 9 and 10 of the rib cage, do a closed chest drainage, and Ling Ran, check on the stomach again."
For a resuscitation of this scale, the thoracotomy closure was like playing the slippery slide in Disneyland. Zhao Leyi simply sutured it and offered up the surgical field to someone else.
Ling Ran performed a barehanded examination and said, "There's a 0.39-inch cut."
Doctor Du came up this round. He performed an inverted suture before he put a gauze for bleeding control, sprayed the fibrin sealant, put in the drainage tube, and used saline solution to wash it
Huo Congjun turned around again and asked, "How is the bleeding?"
The anesthetist who monitored the surgery at the same time gently shook his head.
"There is still a bleeding point. Keep looking." Huo Congjun looked cool and calm on the surface, but he kept cursing in his heart.
In a case where there were multiple knife wounds over the whole body, the most troublesome thing would be the number of lacerations on the body. Sometimes, if the knife cut deeper, it would injure the organ at the area. If the tip of the knife was very thin, it would be very difficult to find the bleeding point.
Blood transfusions could not prolong the patient's life for long, especially under the circumstance where the internal organs bled heavily and the bleeding could not be stopped in the surgery. Many of the patient's organs would soon malfunction. It would then lead to an increasingly severe shock and cause any subsequent resuscitation to become meaningless.
Huo Congjun tried to think in a positive way. Luckily, the bleeding point was not discovered after the abdominal closure. Otherwise, the second exploratory laparotomy would be even more tedious.
"Can you find it?" Huo Congjun asked Ling Ran first.
"There is a hole at the lower right abdomen, but it shouldn't be the one." Ling Ran tried to find the bleeding point. He, too, had several beads of sweat on his head.
Perfect Level Barehanded Bleeding Control did not mean that it could solve every bleeding problem perfectly.
"How much longer do you still need?" Huo Congjun sweated so much that the nurse was not able to wipe it all off.
"I don't know," Ling Ran answered softly.
"Then, we'll suture the part that you just found." Huo Congjun immediately made a decision before he turned around and said, "Ask a radiologist to read the CT scan and find the possible location."
The circulating nurse voiced her acknowledgment of the order before she walked out of the operating theater and asked the radiologist who was reading the scans to come over.
However, he, too, could not provide the exact location of the blood vessel that was bleeding massively.
"Let me search for it a little longer." Ling Ran did not know how to read CT scans, so he could only rely on his bare hands to control the bleeding.
Huo Congjun frowned and nodded. He started to think from the beginning.
"Uncle Jiang, come on!"
"Mister policeman, come on!"
"Uncle Jiang, Uncle Jiang!"
Some children's voices were heard from the back. At some point in time, the other injured teachers and students were also delivered to the hospital by the ambulance.
Most of the students were injured when the bus was driven abnormally. Some of them were severely injured and received six to eight stitches. Meanwhile, those who just had minor injuries only had some abrasions and bruises on their skin.
Despite this, the group of elementary students who were in second grade or third grade looked very pitiful with their heads covered by gauzes and their hands wrapped under bandages.
Normally, if children were injured like this, they would probably burst into tears. Perhaps the children had already cried enough for their injuries, or perhaps it was because of something else, but under the restrictions set by their teacher, they looked very tensed as they stood on their tiptoes and looked into the direction of the resuscitation room.
Suddenly, a child started to sing the national anthem, and he was followed by all the children.
"Get up! Those who won't be slaves!
"With our flesh and blood, let's build a new Great Wall!
"As the Chinese people face its greatest danger everyone's forced to let out one last cry." 
The voices from the children used to make people happy during normal days. At the moment, their voices only added to the glumness.
Jiang Li's family and colleagues were already very nervous. At this time, they could not help but stand and sing along.
The resuscitation room was already very serious to begin with, and it became more solemn at the moment.
Jiang Li's family and colleagues did not know anything about medicine. However, from the serious facial expressions of the doctors and long hours of waiting, they could roughly know what was going on.
The blood stains on the floor became greasy liquid, the clothes which were torn and fell to the ground had been put aside, and the high number of infusion tubes swayed about among the arms of the doctors.
Only the monitors kept letting out a very monotonous cry.
"Get up! Those who won't be slaves!
"With our flesh and blood, let's build a new Great Wall!"
The song was sung again and again. The children's voices became lower, and their faces redder.
The nurses felt troubled, theylooked at the head nurse because they did not know whether they should stop them.
"Help me wipe my sweat." Ling Ran turned his head to the side to make it easier for the nurse to wipe his sweat.
From his angle, he could see the scattered group of children, their serious faces, and the tears in their eyes.
Wang Yi, who was Jiang Li's fiance, burst into tears.
After resuscitating the policeman for two continuous hours, bags of blood were used up, and the result of the resuscitation was almost clear.
"I need to change into new gloves." Ling Ran suddenly changed his posture and jumped down from the gurney. He did not care how the people looked at him, he just removed his blood-stained gloves and threw them away before he turned around and left the operating theater. Then, he washed his hands again.
After cleaning his hands, Ling Ran took out a blue bottle that he had kept for a long time and drank all the liquid from the bottle. It was the skill serum that allowed him to have an increase in level for all his skills, and it lasted for two hours.
Then, right before Ling Ran's eyes, he saw a dense list of skills. The most obvious was still the skills that he had learned.
[Appositional Suturing Technique: Perfect Level]
[Epineurium Anastomosis Technique: Perfect Level]
[Perineurium Anastomosis Technique: Perfect Level]
[Physical Examination Skill: Master Level]
Behind his barehanded bleeding control skill was a pale purple color that Ling Ran had never seen before, and in the color were these words: Legendary Level.