A Surgeon Who Uses Martial Arts [EN]: Chapter 53

The Martial Surgeon – Episode 53

Chapter 9: Next Destination (3)

“This patient has cardiac tamponade.”

Jun-hoo said with a serious expression.

Cardiac tamponade.

It was a condition in which blood accumulated in the membrane surrounding the heart, compressing it.

This results in increased pressure on the heart, decreased cardiac output, and symptoms such as a drop in blood pressure.

The problem was that cardiac tamponade, along with aortic rupture, was an ultra-emergency condition in the field of thoracic surgery.

The patient’s blood pressure, which had been maintained with epinephrine, was dropping.

The electrocardiogram [ECG or EKG, a test that records the electrical activity of the heart] fluctuating ominously again was a major sign of cardiac tamponade.

“It seems the patient hit their chest hard on the steering wheel during the car accident.”

“…….”

“Cardiac tamponade can also be caused by trauma.”

“If we’re looking for a cause, that would be it. Sigh… but why cardiac tamponade of all things? First, call thoracic surgery.”

“Yes, Doctor.”

Jun-hoo rushed to the station.

Perhaps it was because of the situation, but even the time it took for the signal to ring felt as long as taffy.

If emergency treatment was delayed, the patient had a high probability of dying.

Considering the time from when the patient was in the car accident to when they were brought to the emergency room and received treatment, there wasn’t much time left.

To put it in perspective, it was as if the Grim Reaper was right behind the patient.

Jun-hoo glanced around the emergency room, which was in utter chaos.

“Doctor, please secure a central venous catheter for this patient.”

“Apply gauze and bandage it. The femoral bleeding is still severe.”

“How much longer for the blood pack (transfusion pack)?”

The staff were yelling to communicate.

Gowns were soaked or splattered with blood, and every treatment action seemed urgent.

Only guns and swords were missing.

The emergency room was a brutal battlefield where life and death crossed paths.

At this rate… I won’t be able to get any help?

Jun-hoo’s brow furrowed as he surveyed the emergency room.

The emergency medicine residents and professors were all deployed to treat the car accident patients, and everyone was incredibly busy.

It felt like he would get hit if he asked for help.

So, the only place Jun-hoo could rely on right now was thoracic surgery.

Please pick up quickly. The patient is dying.

While Jun-hoo was unusually anxious, the call finally connected.

“This is the emergency room. We have a cardiac tamponade patient; please send down a resident quickly.”

Jun-hoo’s tone was rapid-fire.

-What is it, Seo Jun-hoo?

The owner of the familiar voice was Jun-shik, the first-year thoracic surgery resident who had a conflict with Jun-hoo over the pleural effusion patient yesterday.

A cold sense of foreboding ran down Jun-hoo’s spine.

“Yes, it’s me.”

-The patient has cardiac tamponade?

“Yes. It’s urgent, so please perform pericardiocentesis [a procedure to remove fluid from around the heart].”

-Really? But what a shame. There’s no one available to come down to the emergency room right now.

Contrary to the word ‘sorry,’ there was no apology in Jun-shik’s words.

The foreboding began to become clearer; it began to take shape.

-It looks like you’ll have to wait about 20 minutes.

“20 minutes? That’s impossible! The patient could die.”

Jun-hoo’s voice rose.

It was a miracle that they had lasted this long with CPR [cardiopulmonary resuscitation], medication, and internal thoracic compression.

But wait a full 20 minutes?

Was he telling him to abandon the patient and let them die?

“I’ll give you the patient’s number, so take a look. You won’t say that then.”

-Regardless of the chart number, what can I do if there’s no one available? Should I create someone out of thin air?

Jun-shik continued, sneering.

-It’s the regular surgery schedule, so we’re short-handed. I can’t do pericardiocentesis either.”

“…….”

-You know we’re short on thoracic surgery residents, right?

“So, you’re saying you absolutely can’t come for at least 20 minutes?”

-Yes. Wait 20 minutes or have the emergency medicine department take care of it. You should have a doctor who can do pericardiocentesis in your department.

“I understand.”

Jun-hoo hung up with a heavy heart.

The worst-case scenario he had feared unfolded.

The thoracic surgeon couldn’t come right away, and the senior emergency medicine residents were all busy with emergency treatment for the car accident patients.

He had suddenly become stranded.

Then, there was no choice but to use the last resort….

Clatter.

Clatter.

Jun-hoo grabbed a pericardiocentesis set from the dressing cart and rushed to the bedside.

“When is thoracic surgery coming?”

Sung-min, who found Jun-hoo, asked.

“No. They said it will take 20 minutes.”

“Damn it, I’m going crazy. The patient’s vitals have dropped even more than before. They definitely can’t last 20 minutes.”

“Doctor, can you do pericardiocentesis?”

“If I could, would I have told you to call thoracic surgery?”

Sung-min added that only 3rd or 4th year residents perform pericardiocentesis.

In fact, even 3rd and 4th year residents were so burdened by pericardiocentesis that they usually called thoracic surgery.

Then Jun-hoo’s gaze rested on the patient.

If he couldn’t save this patient, he would have nightmares for the rest of his life.

No, reality would become a nightmare.

If he couldn’t do anything even with this patient in front of him, what difference was there between his past self and his current self?

His heart ached at that question.

“If there’s no one to help, I’ll do it. Pericardiocentesis.”

* * *

“You’re going to do pericardiocentesis? Are you crazy?”

Sung-min clicked his tongue and asked.

Jun-hoo’s idea was utterly foolish.

Not even a 2nd year emergency medicine resident, but a 2nd day resident was going to do pericardiocentesis?

It was like a child who hadn’t even taken their first steps saying they were going to run a marathon.

It was reckless.

“Hey! Do you think pericardiocentesis is some kind of child’s play? What are you going to do if you accidentally stab the heart?”

“I’ll just do it well.”

“Anyone can say that!”

“Then, are you going to do it, Doctor? Or are you just going to sit here for 20 minutes?”

Jun-hoo continued with a cold expression.

“If the patient goes into shock again, we won’t be able to save them.”

“That’s true, but….”

“Then, it’s right to do a fundamental treatment even if there’s a risk.”

Sung-min bit his lip at Jun-hoo’s point.

He felt suffocated.

He was afraid of the shock that would come again if he abandoned the patient.

He was afraid that problems would arise if he performed pericardiocentesis.

It was a desperate feeling with enemies approaching from the front and back.

“Oh, whatever. Let’s do pericardiocentesis, but I’m not confident, so you do it.”

Sung-min came to a conclusion after a brief moment of contemplation.

-You were just watching Jun-hoo do pericardiocentesis? Do you even have a brain?-

He was afraid of getting scolded later, but he was even more afraid of problems arising from doing the procedure himself.

No. Maybe this is an opportunity?

If I make an excuse that Jun-hoo did the pericardiocentesis on his own while I wasn’t watching, that’s it, right?

Sung-min made an escape route and let out a sigh of relief.

“I’ll assist you, so do a good job.”

“Yes, Doctor.”

“I’ll set up, so you bring the ultrasound machine.”

Soon after, Jun-hoo, who had brought the ultrasound machine, returned to the bedside.

It had only been a short time of about 2 minutes, but even in that time, the patient’s vitals were plummeting.

There really wasn’t much time left.

I may hate you.

I’m going to put all the blame on you if you fail the procedure.

But I hope you succeed this time. Save the patient with your great skills.

Sung-min didn’t show it, but he cheered for Jun-hoo in his heart.

Hating Jun-hoo and resuscitating the patient were separate matters.

“Are you ready?”

“Yes.”

“Let’s start.”

Sung-min applied gel to the patient’s left chest and rubbed the patient’s chest with the probe.

The patient’s heart image began to appear on the ultrasound monitor.

“Here it is. Did you confirm?”

Sung-min pointed to the monitor with a nod.

There was a pure white shadow in the lower right of the patient’s heart. That meant that blood was pooling there.

“Confirmed.”

Jun-hoo nodded and put on surgical gloves.

Snap!

The feel of the surgical gloves sticking to his skin felt particularly tight today.

Swish.

Swish.

After widely disinfecting the patient’s chest with povidone solution [an antiseptic], Jun-hoo held the syringe in his hand.

The patient was unconscious, so he did not administer anesthesia.

In fact, pericardiocentesis, the treatment for cardiac tamponade, was simple.

He just needed to pierce the pericardium [the membrane enclosing the heart] where the blood was pooling with a needle and then aspirate the blood.

However, the problem was that the puncture had to be done in the correct area.

The depth of the puncture should not be too shallow or too deep.

In particular, if the puncture was too deep, it could damage the heart.

There’s no need to be nervous.

It’s the same as the way you used a sword in the Murim world [a fictional martial arts world, often found in Korean and Chinese novels].

Jun-hoo took a deep breath and calmed his mind.

Direction and distance control were one of the most important elements in swordsmanship in the Murim world.

And Jun-hoo, who had experienced countless battlefields, remembered the know-how needed to control direction and distance at the cellular level.

Why?

Because if he mishandled the sword even once, a tragedy would occur where he would lose his life to the Demonic Realm.

“Here I go.”

Thump!

As soon as he finished speaking, the needle pierced between the patient’s 6th and 7th ribs.

The 2nd form of the Azure Cloud Sword Technique passed down from the Seo Clan: Azure Cloud Needle.

He used the principle of the form of an awl piercing through the clouds.

With the needle inserted, Jun-hoo slowly applied force to his hand and advanced the needle towards the patient’s pericardium.

Although he couldn’t see the needle advancing because of the skin, Jun-hoo was watching the needle’s path with his mind’s eye.

While practicing anatomy under the anatomy professor, Jun-hoo learned 3D mapping technology.

In other words, he learned the technique of imaging and drawing the patient’s bones, nerves, and blood vessels in his head.

It was like a kind of X-ray vision.

Good.

It’s moving while avoiding the intercostal nerves and blood vessels, and it avoided the lungs well too.

The pericardium is coming up soon. Let’s keep going like this.

Despite the ultra-emergency situation, Jun-hoo was calm.

His expression was calm, and his hands were mechanically steady.

The heart of a beast, which is considered an essential element for a surgeon, Jun-hoo had already mastered it in the Murim world.

Thud!

A strange sensation different from before was transmitted from the tip of the needle.

It was a sign that the needle had pierced the pericardium.

“Hey, is it going well? You’re really going to die if you stab the wrong place.”

Jun-hoo didn’t even blink at Sung-min’s harsh words.

He was just retracting the syringe plunger.

Gurgle.

Bright red blood was drawn into the syringe barrel. The color of the liquid mixed with blood and effusion was subtle.

Now Jun-hoo’s eyes were directed at the ultrasound monitor, not the patient’s chest.

The white shadow located in the lower right of the heart was gradually disappearing.

It was evidence that the fluid that had accumulated in the pericardium was being drained out with the syringe.

It was evidence that Jun-hoo’s pericardiocentesis was a great success.

“It’s over.”

Jun-hoo closed the syringe cap and let out a sigh of relief.

If CPR was resuscitation, pericardiocentesis was a fundamental treatment that eliminated the cause of the disease.

Was that why?

As soon as the pericardial fluid was removed, the patient’s vitals quickly began to return to normal.

The electrocardiogram, which had been erratic like a runaway prodigal, also returned to its original course.

Only then did Jun-hoo feel a vivid sensation as if he had returned to the world.

The urgent scenery of the emergency room, the smell of disinfectant and blood that brushed the tip of his nose, and the staff’s loud shouts were the senses that he had briefly forgotten when he was concentrating solely on his senses while performing pericardiocentesis.

“Now, if we put in an order for a test and follow up well, it seems like it will be okay.”

“That’s right. I’ve finally relieved a little bit of my worries.”

Sung-min wiped the cold sweat from his forehead with the sleeve of his gown, then looked at Jun-hoo with a dumbfounded expression.

“But you’re really something. You succeeded in this in one try?”