Fifth Vital [EN]: Chapter 135

Fifth Vital Sign – Episode 135

Episode 135. Such a Messy State

“Although the vitals are stable, let’s prepare for the worst, just in case. Have the intubation kit and CV cath [central venous catheter, a thin tube inserted into a large vein] ready, but don’t open them yet; just have them nearby.”

“Yes, Doctor.”

“Intubation and CV cath are ready.”

“And since we’ll secure it as soon as the pulse appears, prepare norepinephrine (vasoconstrictor) and three 2L bags of Plasma Solution (a type of IV fluid with an electrolyte ratio similar to body fluids).”

“Understood.”

“Administer tazobactam (antibiotic) immediately upon arrival and send out for a full lab (blood test). Also, please have the colleagues who are coming with him register at the reception desk right away.”

“Yes, Doctor.”

“No, I’ll call the reception desk myself.”

“You will, Doctor?”

“Yes.”

Tae-kyung, volunteering to handle the reception, picked up the phone.

– Hello.

“This is Kim Tae-kyung.”

– Yes, Director.

“We have an amputation patient arriving soon. Could you please register the patient as ‘unknown’ for now and correct it later? Yes, I’ll place the orders in advance. Thank you.”

Tae-kyung called the reception desk directly to expedite the patient’s treatment.

“Let’s do our best for the next 15 minutes.”

“Understood.”

“Yes, Doctor.”

If excessive bleeding occurs due to the amputation and infection develops through the injured area, the situation becomes truly serious. Therefore, constant vigilance and alertness were essential.

“And those with available manpower, please stand by near the trauma bay.”

Tae-kyung, as always, prepared excessively.

Perhaps if a hired doctor over-allocated resources like this, the employer might disapprove. However, Tae-kyung was in charge, so he could focus solely on the patient and allocate resources without worrying about anyone else’s opinion.

“Contact Dr. Lee Chan-hee and have him come to the emergency room. And since it’s an explosion, there might be head injuries. Tell the CT staff to stand by and bring out the trauma ultrasound.”

“Doctor, should we prepare for cardiac arrest as well?”

“No. That’s okay. I’ll order it if there’s a possibility.”

“Yes.”

“And prepare several pads and a tourniquet to prepare for massive bleeding.”

“Understood.”

Screech-

Tap- Tap-

Medical staff bustled around Tae-kyung, setting up equipment and preparing to receive the patient.

“And have someone go outside and open all the automatic doors. Guide them to park right at the emergency room entrance, and call ahead to have any regular vehicles near the entrance moved immediately.”

“Yes, understood.”

Every staff member moved in perfect order at Tae-kyung’s command. Each time, they were amazed by his meticulousness and thorough preparation.

“Our director is the king of thoroughness today, too.”

“Is this your first time seeing it?”

“That’s how we can care for patients right away.”

“That’s right. He’s such a consistent person.”

Tae-kyung prepares for each patient, even considering minor details that other staff members might not think of, all for the sake of the patient.

Knowing that it is solely for the patient’s benefit, the staff genuinely trusts and follows his instructions.

Rrrrrrrrrrr

“Emergency Room. Yes, understood.”

“The amputation patient will arrive in 5 minutes.”

Tae-kyung, hearing Nurse Im Jeong-sook’s announcement, headed to the head of the trauma bay bed. He activated the ultrasound machine and checked the intubation tools.

He simulated various scenarios in his mind, preparing to give detailed instructions when the patient arrived.

It wasn’t out of nervousness or worry. He was simply focused on doing his best to save the patient.

After 5 minutes, the awaited patient arrived.

“119 is here!” [Korean emergency services, similar to 911]

“Patient has arrived!”

“Bringing in the bed!”

Screech-

The ambulance stopped, and the patient was quickly unloaded on the bed. More than the usual four paramedics escorted the patient rapidly into the trauma bay.

The sight of the patient in the 119 firefighter uniform gradually came into Tae-kyung’s view, starting from the head.

The fifth vital sign, the stage 3 odor that had been present since entering the emergency room, strongly filled the treatment room. It was a strong odor, belonging to the ‘high’ category of stage 3 [indicating a severe infection].

In such cases, the patient could immediately progress to stage 4, depending on their condition.

“Okay, let’s move the patient. One, two, three!”

“Cut off the clothes first. Cut the chest and legs well.”

Snip- Snip-

At Tae-kyung’s direction, the medical staff cut the firefighter’s clothes.

“Paramedic, please hand over the patient.”

“Yes, Doctor, so we were at the scene… We went in after suppressing the fire, but a secondary explosion occurred in the lab, and this… this happened.”

The paramedic who came with him seemed strange.

“And this guy lost a lot of blood. During the suppression and evacuation, the explosion happened near his leg… Doctor? Seung-won… that son of a… Ha!”

“Okay, Paramedic, please step outside for a moment. Thank you for your hard work.”

It was a completely different demeanor than usual. When paramedics bring a patient, they accurately hand over the patient’s condition.

They convey every detail to the medical staff, including what treatments have been done so far and the situation upon discovery.

But the current demeanor was like that of a guardian when their family is injured. It was a natural reaction, considering that a colleague, no different from family, was injured before their eyes, causing them to be out of their minds.

Tae-kyung understood that feeling better than anyone, so instead of raising his voice, he quietly asked them to leave.

“Doctor! Please take care of him!”

The team leader of Do Seung-won, who came with him, said with worried eyes.

“Please take good care of him.”

“Please take good care of our Seung-won.”

Other paramedics standing at the entrance of the treatment room also pleaded loudly with worried expressions.

Tae-kyung didn’t say anything in response to their words. Instead, he answered with a heavy gaze.

“Team leader, what about Seung-won?”

After the treatment room door closed, the remaining paramedics worried about Do Seung-won with troubled expressions.

“Shouldn’t we tell Seung-won hyung’s [older brother or close male friend] girlfriend that he’s hurt?”

“She already knows. The building where the accident happened is Seung-hee’s workplace. She’s probably on her way. I told her which hospital it was.”

The team’s youngest member cautiously spoke, and another colleague replied.

“What! Is that true?”

The team leader jumped up in surprise at those words.

“Yes, I saw Seung-hee outside the building earlier while waiting and she told me directly.”

“So that’s why Seung-won’s expression was like that earlier… The son of a gun was anxious because he was worried his girlfriend might be inside.”

The Yeoul Fire Station team leader finally understood why Do Seung-won had been acting strangely just before the suppression.

“Didn’t Seung-won hyung say he was going to greet his girlfriend’s parents? But with his leg… how can he go with such an injury.”

“Ha! Poor guy.”

The team members couldn’t easily continue speaking and felt upset as if it were their own problem.

* * *

Treatment Room-

“Patient! Patient! Do you know where you are?”

Although his eyes were clearly open and there was a slight strength in his limbs, Do Seung-won didn’t say anything.

“Patient, are you unable to speak right now? Patient!”

Out of frustration, Lee Chan-hee raised his voice slightly. Meanwhile, Do Seung-won’s affected area, where his clothes had been cut off by the medical staff, was revealed.

Everyone’s gaze fell upon his devastated right leg.

“……!”

The calf area below the knee of his right leg was gone.

‘Oh my!’

Do Seung-won’s right leg was truly a mess.

It wouldn’t be appropriate to describe the patient’s painful area as a mess. But looking at the injured area now, that expression was the most accurate.

Pieces of clothing, nearby building debris, and flesh and muscle were all fused together due to the aftermath of the explosion.

In short, it was in such a messy state.

“Above the affected area, yes, there. I’ll apply a tourniquet (a device to block bleeding by compressing limbs). Please check the tourniquet time from now on.”

The medical staff followed Tae-kyung’s instructions well and accurately divided their tasks.

One side attached devices to the patient to check his vitals, while the other side prepared to draw arterial blood while touching his groin.

Tae-kyung looked at the patient’s wound before even hearing the blood pressure readings and put on sterile gloves to secure a CV cath (central venous catheter).

“Patient BP (blood pressure) is 95/75, HR (heart rate) is 85.”

“I’ll secure the central venous catheter. Turn on the oxygen saturation monitor, and did you draw arterial blood?”

“Yes, Doctor.”

Lee Chan-hee quickly continued the response.

“Blood has been drawn and is being sent to the machine now.”

Tae-kyung held a cotton swab soaked in povidone solution and broadly disinfected the patient’s right clavicle. Then, he pierced a long needle, about 15cm long, from the middle of the patient’s clavicle. Do Seung-won, who had shown no reaction, frowned.

“Ugh!”

From his reaction, it seemed he was conscious and could speak, but he was in a state of shock. The patient’s state of mind was probably as devastated as his leg.

Blood pooled in the syringe at the handle of the needle Tae-kyung had pierced. Afterward, the nurse handed over the catheter (an insertion tube that extends from the blood vessel to outside the skin), and Tae-kyung procedurally inserted it along the needle.

“Give 1L bolus of plasma through the catheter (administer by fully opening the control valve).”

While Tae-kyung was securing the central venous catheter, nurses were drawing blood from Do Seung-won’s arm for testing. At the same time, Tae-kyung turned on the ultrasound machine and placed the probe (the part that touches the affected area to view the ultrasound, about the size of a palm and connected to the main unit by a wire) on the patient’s abdomen.

‘Let’s check the abdomen, too.’

Since he was directly at the explosion site, there might be hidden abdominal trauma.

Tae-kyung watched the monitor connected to the ultrasound machine with sharp eyes, carefully observing the abdominal condition.

“Dr. Lee, here.”

The nurse ran over and handed Lee Chan-hee a piece of paper.

“Arterial blood results are in. pH 7.3, pCO2 50, pO2 80, O2SAT 91.”

Lee Chan-hee checked the paper, reported, and gave instructions.

“I’ll set it to 5L via nasal cannula.”

Tae-kyung, with his eyes fixed on the monitor, nodded in agreement while listening to the report.

After thoroughly examining various parts of the abdomen, he stated the results.