The Enhanced Doctor

Chapter 1277: Chapter 1277: Pulmonary Blast Injury

"You came too? Have you had dinner yet?"

Having just run to the lobby and waiting here to take over the case, Chen Xuehai asked.

"Yeah. We still don’t know how big the tire was. I’m worried it was from a heavy truck—if it blew him away, the pressure must’ve been huge." Liu Banxia said.

"The New Year has just passed, right? Can heavy trucks even be out on the road this early?" Chen Xuehai asked.

"Who can say for sure? Let’s see what we’re dealing with in a bit." Liu Banxia said.

Anyway, whether it was a truck tire or a car tire, if it blew the person clear off his feet, that alone shows the air pressure at the time wasn’t small.

After a few more minutes of waiting, the ambulance could be heard arriving at the entrance.

"Patient comatose, blood pressure 140/90, heart rate 130, SpO₂ 95. Large-area blunt contusion to chest and abdomen, rib fractures present. We’ve given blood and fluids in the ambulance; family is on the way."

The paramedic pushing the patient down said.

"Resuscitation Room One. Do you know his baseline medical history?" Chen Xuehai asked.

"He’s a heavy truck driver, was doing maintenance on the vehicle. Family wasn’t around. The people in the parking lot know him fairly well, but don’t have a handle on his medical history." the paramedic said.

"Let’s examine him first; this looks pretty serious. One-two-three, transfer to bed. Chest X‑ray." Chen Xuehai said.

Once the X‑ray was done, both Chen Xuehai and Liu Banxia frowned.

Multiple rib fractures, contusions to both pulmonary arteries—these injuries were really not mild.

"You check the chest; I’ll take a look at the abdomen." Liu Banxia said.

"Order ECG, CBC, serum biochemistry, coagulation profile, blood gas analysis, cross‑match, and book a CT slot, urgent." Chen Xuehai nodded and said.

Liu Banxia hurried to perform an abdominal ultrasound on the patient.

"Not bad, I didn’t find any issues. Looks like I’m off the hook for now." After finishing the exam, Liu Banxia said.

But as he auscultated the patient’s heart sounds, Chen Xuehai’s face remained expressionless. "You listen too. I think I’m hearing premature beats. Not sure if it’s caused by airflow turbulence. The breath sounds are also a bit weak now."

Liu Banxia quickly auscultated the patient’s chest as well, and his brow furrowed too. "It’s not just premature cardiac beats. When I listened to both lungs, I think I also heard scattered, variable crackles. Could this be a lung blast injury?"

"That’s what I’m worried about. You secure the airway with intubation first, then we’ll get another chest X‑ray." Chen Xuehai said.

Even though he was being ordered around, Liu Banxia didn’t dare delay and hurried to intubate the patient. Lung blast injury is quite dangerous for a patient, and since he was blown away by a tire explosion, the likelihood is even higher.

Because when an explosion occurs, it generates a shock wave.

The continuous overpressure–underpressure of the shock wave acts on the human body, causing rapid compression and expansion of the chest and abdomen, leading to damage to the heart, lungs, and blood vessels.

The shock wave can damage all tissues and organs in the body, with gas‑containing organs being more susceptible. Under this continuous pressure change, an implosion effect can occur.

Fortunately this was "only" a tire explosion. If high temperature had been involved at the moment of explosion, the patient’s injuries would be much worse, and he might not even have had a chance for resuscitation.

After finishing the intubation, Liu Banxia stepped back to the side.

Looking at the new X‑ray film, the two glanced at each other and saw the heaviness in each other’s eyes.

The patient’s lungs on both sides were already showing whitening. Based on his current presentation, this completely matched lung blast injury.

"Shit, his blood pressure and oxygen saturation are starting to drop."

At this moment, Liu Yiqing called out.

"Don’t panic, give oxygen first. Notify the ICU to prepare ECMO, and urgently get in touch with the family. Director Liu, let’s do chest tube insertion together." Chen Xuehai said.

Without wasting words, Liu Banxia moved directly to the patient’s right side.

"We go all out on resuscitation. I just reached the patient’s wife and got authorization." Outside, Qi Wentai also shouted.

"Explain to her that this is lung blast injury and we need to put him on ECMO. If possible, once we finish the immediate management, we’ll transfer him straight to the ICU." Chen Xuehai said.

"Got it."

Qi Wentai responded.

It’s also because ECMO will incur relatively high costs. And even with it, whether the patient can ultimately be saved is still unknown.

"Lung blast injury very easily leads to tension pneumothorax. Right now his lungs are gradually losing function. Air from the lungs is leaking into the pleural cavity, so we have to put him on ECMO."

While inserting the chest tube, Liu Banxia gave the other interns in the procedure room a brief explanation.

"Next we still need to assess how severe the lung damage is. If it’s too severe, the only option will be to wait for lung transplantation. If it’s not extremely severe, we still have a chance to save him."

"OK, I’m done on my side. What’s his oxygen saturation now?" Chen Xuehai asked.

"The drop in SpO₂ has slowed. It’s at 88 now." Liu Yiqing said.

"Push him to ICU first. We’ll do the CT a bit later once everything else is set." Chen Xuehai said.

Ding! Emergency admission completed.

Gained 200 experience points, Glory Points +30.

Everyone hurried to wheel the patient out.

"Go all out on the resuscitation, I just reconfirmed things with the patient’s wife," said Qi Wentai, standing at the door.

That put Chen Xuehai at ease. As long as you resuscitate, there’s still hope; if you don’t, then there isn’t even the tiniest bit of hope.

Liu Banxia didn’t follow them upstairs; the rest of the work was for ICU and thoracic surgery.

"President Qi, keep an eye on it for a bit, yeah? I haven’t even finished my meal, don’t know if they saved it for me," Liu Banxia said.

"Alright, go on. There’s nothing else going on today," Qi Wentai nodded.

Back in the cafeteria, Wang Chao and the others had just finished eating.

"Back this fast? Not serious?" Wang Chao asked.

"Very serious. Lung blast injury, but nothing much in the abdomen. Lung damage is bad, they’ve already pushed him to ICU for ECMO," Liu Banxia said.

"Damn, that serious?" Wang Chao was startled.

"Exactly. None of us expected just a tire blowout to do this. Usually it’s pressure cookers, chemical reagents, gas explosions and that kind of stuff that cause lung blast injuries. His luck was really on the crappy side," Liu Banxia said.

"Good thing it was caught in time. If we’d sent him for a CT, it might’ve delayed the resuscitation. By the way, did someone put my food away? They didn’t just toss it, right? I need to keep eating, I’m not full yet."

"Manager Zhou put it away for you. If I’d known you’d be back this fast I would’ve just left it. Wasted a lunch box, and it still has to be washed," Wang Chao said.

"Get lost. Give me your meal card, I’m gonna order another dish to top up my energy," Liu Banxia said.

Wang Chao curled his lip.

Give him the meal card? No way. It’s already generous if he doesn’t rob me blind.

"What about your food? It’s cold already. Heating it up by itself is a pain," Zhou Qiang said with a grin.

"Throw in two eggs for me, just fry it up randomly," Liu Banxia said.

"Got it. Otherwise nuking it in the microwave is a hassle too. If we’d known you’d be back this soon, we wouldn’t have put it away," Zhou Qiang nodded.

"I knew you’d have us on your mind. Otherwise how would I dare drop my tray and run without saying a word?" Liu Banxia said with a laugh.

"Alright then, just for that line, these two eggs are on the house from your big brother. Enough to eat? If it’s not enough I’ll add two more," Zhou Qiang said happily.

"Don’t add more, these two are pretty much enough. After I’m done I’ll go upstairs and drink some tea, that’ll be plenty," Liu Banxia said.

Honestly, it was just putting together a makeshift meal.

If he sat and ate all in one go, Liu Banxia could pack away a lot. This kind of ’installment plan’ meal does take a bit of the edge off your appetite.

And these past couple of days haven’t been that busy, so he hasn’t been burning that much energy.

In no time the food was stir-fried and brought over in a big bowl.

"How’s it been lately, you guys busy?" Zhou Qiang took the chance to sit down next to him.

"Not bad. It’s the New Year period, so apart from a few more car crash patients last time, it’s actually not that busy," Liu Banxia said.

"What’s wrong? Don’t tell me you’ve lost confidence about taking over the contract? It’s still early, you know. Everyone’s trust in this place of yours is pretty high."

"That I’m not worried about. If they really don’t pick me, worst case I just earn a bit less. If I open a proper restaurant, it’d definitely be less of a headache than doing this," Zhou Qiang said with a smile.

"I’m really not bragging here—this place does make money, but it’s exhausting. My whole family more or less has to pitch in,"

Liu Banxia nodded. "That’s true. Even just doing breakfast you have to get up that early. Everything else is manageable, but the steamed buns and rolls, those have to be steamed fresh in the morning."

"The key is, in a regular restaurant, they all have closing hours. But here? You can’t really ’turn off the stove,’" Zhou Qiang said.

"Families of patients tend to eat in more concentrated time slots, but you guys who are constantly on the operating table are different. It’s not just about feeding you, it’s about feeding you enough, otherwise how are you supposed to keep doing this job?"

"I may only be a cook by trade, but after all these years in the hospital, just listening in I’ve picked up a lot. The work you guys do really eats up your physical strength."

"I heard them chatting that you’re going to do a liver transplant? Impressive. They say if that surgery goes smoothly it still takes sixteen or seventeen hours, and if it’s even a little rocky, you might end up grinding through two whole rounds of it."

"Yeah. I’ve got a bit of a headache about it myself. I actually wanted to ask Director Zhou to handle the liver harvest, but for me right now this is a rare opportunity, so I’ve got to tough it out myself," Liu Banxia said.

"When you’re about to scrub out, give me a heads-up in advance. I’ll time it and get things ready for you guys, that way you can have a bit more rest time," Zhou Qiang said.

"A surgery that big, going that long—how are you supposed to get through it without eating something in the middle? Even if you can tough it out, others might not,"

Liu Banxia nodded. "Thanks. Just make us some dumplings when the time comes, that’s enough, they’re quick to eat. Beef and onion, yeah? Meatballs in the filling taste good and really fill you up."

"Haha, sure. I’ll season the filling the night before," Zhou Qiang said cheerfully.

This was just the personal relationship between the two of them; he wouldn’t be this enthusiastic in his prep for anyone else.

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