Chapter 94 - Retroperitoneal Hematoma

Chapter 94: Retroperitoneal Hematoma

Translator: EndlessFantasy Translation Editor: EndlessFantasy Translation
Zheng Ren entered the ICU and felt hateful gazes directed at him.
‘What did I do?’ Zheng Ren thought.
He had never had any misunderstandings with ICU staff. The nurses…
“Chief Physician Pan, you’re here.” An ICU doctor walked toward them and started to explain the patient’s condition.
“The patient was involved in a traffic accident and sent to the fifth orthopedic department at 9:18 am. He was diagnosed with a pelvic fracture. Blood pressure was at 100/60 mmHg but an hour later, it was at 85/45 mmHg. We suspected severe hemorrhage from the fracture and did a CT scan. The scan revealed a retroperitoneal hematoma.”
The patient’s records detailed the condition with a simple, clear-cut diagnosis. The hematoma was to be expected due to pelvic fracture.
Minor pelvic fractures rarely required surgery and were manageable with just rest.
The design of the pelvis naturally made it so. Fractures typically led to bleeding that would cause a small to medium internal accumulation. Usually, treatment with hemostatics and antibiotics was sufficient.
However, if the pelvic fracture ruptured any blood vessels, it would be the internal and external iliac veins, along with the common iliac vein.
These blood vessels were located at the retroperitoneal space and the bleed would be enveloped by the peritoneum. In most cases, the ruptured vessel was either a small artery or vein and the bleeding would stop due to higher retroperitoneal pressure.
However…
This patient seemed to be a special case. The odds of a case like this was less than one in a hundred.
It was likely that there had been severe laceration to one of the bigger arteries in the retroperitoneal space and the pressure could not staunch the bleed. The patient’s blood pressure was at a level that indicated hemorrhagic shock.
The higher retroperitoneal pressure was tricky as it did not allow for standard general surgery methods to stop the bleed.
If they cut open the retroperitoneum, the trapped blood would burst out due to pressure.
Zheng Ren looked to the side and saw Su Yun move a chair to the patient’s bedside. He sat by the patient and scrawled something on a piece of paper as if making calculations.
Su Yun could be hungover but did not look drunk, just mildly dispirited.
The gloomy expression on a handsome face like his gave off a completely different vibe.
“Let’s have a look at the patient first,” Old Chief Physician Pan said steadily. He approached the patient and read his vital signs, then proceeded to view the CT scan.
“Pelvic fracture with ruptured arteries. Hematoma in the retroperitoneum.” Su Yun heard Old Chief Physician Pan’s voice and looked up. He did not rise from his seat or look at Chief Physician Pan, but only stared at Zheng Ren.
Zheng Ren knew what he meant.
The patient’s condition was not suitable for open surgery, leaving only interventional surgery the only option for stopping the bleed. That was their priority now.
Su Yun’s diagnosis and rescue plan were accurate. He was sharp.
“Little Zheng, are you confident?” Old Chief Physician Pan was not familiar with this manner of interventional surgery, but after the placenta abruption case, he had bought a book to study it further.
He was not capable of performing the surgery but wanted to make sure Zheng Ren was confident before rushing into it.
Sometimes, hot-headed youngsters need the steady hand of an older fellow to guide them.
A pelvic fracture with retroperitoneal hematoma and developing hemorrhagic shock was the perfect case for an interventional radiology-assisted surgery.
Nevertheless, Old Chief Physician Pan had never performed such surgeries before and wanted Zheng Ren’s opinion.
“No problem,” Zheng Ren replied confidently. “Get the paperwork. Prepare the blood and transfer the patient to the interventional radiology operating room.”
Su Yun’s black hair swayed as he bobbed excitedly. The tiredness in his eyes slowly disappeared.
The change in Su Yun made Zheng Ren cautious. ‘What is this nancy boy up to?’
“I’ll go in with you,” Su Yun said, “These are calculations for contrast agent administration. Don’t mess it up.”
He handed the piece of paper to the nurse.
“Another calculation of contrast agent administration based on urine specific gravity?” the nurse said after glancing at the paper. She had a look of regret on her face. “Brother Yun, it’s a shame you left for the emergency department.”
“Haha.” Su Yun gave a neutral response: a chuckle that accentuated his tousled hair.
Zheng Ren had no patience for Su Yun and his antics but the concept was correct. Using urine specific gravity for calculation, the contrast medium would provide a better chances for a hemorrhagic shock patient.
This was a high-level technique, something akin to a secret move from a Wuxia novel.
With the boom of the internet, this method of calculation was available online for reference. The problem was the complicated mathematics required, something beyond most medical students’ grasps.
They would have to constantly monitor the patient’s urine specific gravity and adjust the contrast medium. The whole process was exhausting.
Hence, anyone who suggested it was already heads and shoulders above others.
This man would do it. Zheng Ren and Old Chief Physician Pan excused themselves from the ICU and went to prepare the interventional angiography system.
After the placenta abruption case, Old Chief Physician Pan had managed to source some of the materials suitable for interventional surgery.
This time, Zheng Ren would be better-equipped. He would have the right instruments and another doctor with him.
…
…
Zheng Ren prepared himself in the operating room.
Xie Yiren was here. She had taken the time to study interventional surgery as much as possible and was ready to assist Zheng Ren.
However, he would not allow her to. This was not coronary bypass surgery that would have the patient’s heart stopped. There was no need for her to be exposed to radiation.
As for Su Yun, Zheng Ren simply did not care if he wanted to help or not.
Between an annoying, sharp-tongued pretty boy or an accommodating, delightful lady, Zheng Ren did not need to think twice about his pick. He was very straight, after all.
They required minimal machinery as it was simply an embolization surgery. In the world of interventional surgery, embolization was the easiest procedure to perform.
Fifteen minutes later, Zheng Ren heard the sound of the stretcher trolley approaching.
The preparations in the operating room were complete.
The patient was gently lifted onto the operating table. Care was taken as not to aggravate the patient’s condition. Zheng Ren activated the system and gave control access to the operating room, then began to scrub in.
Interventional surgery had the risk of radiation exposure, but personnel entering the area had to wear heavy lead aprons as they worked. Operating with pounds of added weight was much more difficult than a normal surgery.
However, in certain cases, interventional surgery was the only viable option. If they did not proceed, it would mean standing aside and watching the patient bleed to death.
Zheng Ren went to the storage room and took out a lead apron. Suddenly, he remembered something.
When he had accomplished the solo mission, the System had rewarded him a silver chest and a special lead apron that could turn radiation into energy.
The silver chest did not entice him after three consecutive unboxings had given him nothing but skill books.
The special lead apron seemed prestigious. According to its description, it could absorb and transform radiation into energy for its wearer.
That would be very interesting.
Zheng Ren returned the lead apron in his hand and snuck a peek at Su Yun. The man was occupied with positioning the patient and other presurgical preparations. Zheng Ren hurried into the changing room and accessed the System, intending to put the special lead apron to good use.