Chapter 383 - 244: On-campus First Aid: Perinatal Spontaneous Hepatic Rupture (3)
Chapter 383: Chapter 244: On-campus First Aid: Perinatal Spontaneous Hepatic Rupture (3)
Director Cui was also pleasantly surprised. He hadn’t expected this method to be so effective.
"It worked!"
Hearing Director Cui’s cry, the students behind him cheered.
Director Duan and Director Guan let out a breath they didn’t know they were holding. The most difficult step was finally complete.
With the video feed from the video laryngoscope, inserting the endotracheal tube was much easier this time. Soon, it reached the glottic fissure, passed through the glottis to the appropriate depth, and the laryngoscope was withdrawn.
"Stethoscope!"
With the aid of the stethoscope, they confirmed the tube’s position and secured it. Director Cui had successfully established an artificial airway!
Soon, Teacher Fu’s breathing, blood oxygen saturation, and heartbeat all began to recover.
Everyone cheered once again.
The next step was to make a diagnosis.
The OB/GYN doctors had preliminarily ruled out a miscarriage or normal delivery.
"Director Cui, Director Duan, Teacher Fu might have internal abdominal bleeding!"
Hearing this, the two directors thought of a plan. With the ambulance yet to arrive and without adequate equipment or conditions, the most convenient option was an abdominal paracentesis.
Teacher Fu’s condition was temporarily stable, so under Director Cui and Director Duan’s direction, she was moved to the campus hospital. At least they had a B-scan ultrasound machine there to aid in the diagnosis.
In the campus hospital, Director Duan performed the abdominal paracentesis on Teacher Fu. Because she was pregnant, he used a 22-gauge paracentesis needle.
Afterward, with the help of a bedside B-scan, the two directors finally diagnosed Teacher Fu’s condition.
Upon seeing the results, both directors fell silent, their expressions turning grim.
Just then, the two deans and Professor Long arrived at the campus hospital.
"How is Teacher Fu’s condition?"
Dean Duan asked.
Director Duan looked at his older cousin and replied with some bitterness:
"The situation is very bad. Teacher Fu has suffered a subcapsular and central liver rupture... There are necrotic lesions and a rupture site!"
Director Cui, standing to the side, gave a more professional summary:
"It’s spontaneous hepatic rupture in the peripartum period—a very rare clinical case."
"This is a rare acute abdomen case in obstetrics. It most often occurs in the middle to late stages of pregnancy. According to the literature, its incidence is about 1 in 25,000, but the mortality rate is extremely high!"
"Based on the students’ description at the time, Teacher Fu’s sudden, violent coughing was the trigger. Her blood pressure was already fluctuating poorly during her pregnancy. The diaphragmatic surface of the liver is large and under high tension, making it highly susceptible to injury."
"The violent coughing led to a spontaneous rupture, causing acute abdominal pain and massive intra-abdominal hemorrhage!"
Director Cui’s knowledge was indeed extensive; he had quickly identified the cause. However, now that he had, he was faced with a dilemma.
"Currently, for peripartum spontaneous hepatic rupture, emergency hemostasis is required. The main treatment methods are open surgery and interventional embolization to stop the bleeding."
"Open surgery has the highest survival rate and is the preferred treatment. However, based on the preliminary B-scan diagnosis, the depth of the liver laceration is clearly greater than two centimeters. A simple mattress suture repair Surgical Technique will no longer be sufficient."
"We haven’t opened the abdomen, and it’s not advisable for a pregnant woman to undergo a CT scan, so we can’t determine the exact extent of the damage. It might require packing with gelatin sponge followed by a mattress suture Surgical Technique on the liver wound margins."
"But it’s also possible the situation is even worse. If Teacher Fu’s liver has extensive stellate lacerations or severe parenchymal tears, and the hematoma affects one hepatic lobe or half the liver, the only treatment would be a debridement and liver resection Surgical Technique!"
Listening to Director Cui’s detailed analysis, Director Duan felt inadequate in comparison.
Director Guan, the two deans, and Professor Long were also deeply impressed.
Dean Duan asked urgently, "In that case, Director Cui, can you operate immediately? Director Duan will assist you."
Director Duan also looked at Director Cui. If Director Cui needed him, he would definitely assist.
At his age, Director Cui was not one to try and be a hero.
’I’m just here to give a part-time lecture,’ he thought. ’I’m not going to put myself at risk. Besides, Teacher Fu’s chances of survival are one in ten.’
He considered many factors. With the campus hospital’s crude equipment and poor conditions, and without a good surgical team to coordinate with, the probability of failure was very high.
Moreover, the patient was pregnant, and his own stamina wasn’t what it used to be. If there was excessive blood loss and the surgery dragged on, it could easily lead to multiple organ failure and death.
Even if a rescue was possible, there were all these objective and subjective factors, not to mention the patient’s own physical condition.
Director Cui mentally calculated the factors affecting Teacher Fu’s prognosis: the amount of bleeding, anti-shock treatment, duration of the surgery, other possible concurrent injuries, systolic arterial pressure, pulse...
He had been through enough in his life and had always landed on his feet precisely because he was a cautious man. He always protected himself first, only taking action when he was certain of a high success rate.
Clearly, Teacher Fu’s current situation did not meet the criteria of his usual code of conduct.
It was just like the liver rupture case he had discussed with the students in class today. Sending the patient to a higher-level hospital with better treatment facilities and a better medical team was the best course of action!
Director Cui decisively refused the proposal to lead the emergency surgery.
"The situation is too dire. Besides, the surgical conditions and the surgical team here are not ideal. I can’t do it alone; we’d need a senior expert from hepatobiliary surgery. I suggest we wait for the ambulance and immediately transfer her to the emergency department at City First Hospital for treatment!"
Director Cui also realized his words might have sounded too cold and arbitrary, so he added an even more impossible alternative.
"There is one other theoretical possibility. We could immediately contact an emergency physician and a hepatobiliary surgeon who specialize in emergency treatment for hepatic rupture bleeding and partial hepatectomy. If they came here for a joint operation, we might be able to pull off the rescue even under these poor conditions."
But here in Fan City, Director Cui couldn’t think of anywhere he could summon such experts so quickly.
As for experts from within the province, getting someone from Xiao City would take far too long. There was simply no time.
The two deans, Director Guan, and Director Duan were all a bit surprised to hear Director Cui refuse to operate.
Their only option, then, was to wait for the ambulance. But waiting for it to arrive and then transporting her to the emergency department at City First Hospital would waste a lot of time.
Director Duan thought of Wu Ting. He stepped aside and immediately gave him a call.
Guan Bao also thought of someone else—Director Zhang Heng, who had also been transferred to City First Hospital from Jin Province Tumor Hospital!
Guan Bao moved to the other side and immediately contacted Zhang Heng.
After finishing his call, Director Duan calmly informed everyone that he had contacted Director Wu from City First Hospital. He happened to be in the responding ambulance, and Director Wu’s specialty was stopping massive hemorrhage from liver ruptures!
Guan Bao likewise announced his success. He had contacted Director Zhang, an expert in hepatobiliary surgery!
He was also on his way.