Chapter 44: Mission: A Buddha to All
The robotic female voice reverberated through space. However, it was not in response to Zheng Ren’s shout. It was here to deliver a mission.
[Emergency Mission: A Buddha to All
[Mission Details: Rescue management of mass poisoning cases in the emergency department
[Mission Reward: 300 skill points, 1 silver chest, 30000 experience points for every 100 patients successfully rescued.
[Mission Duration: 1 day.]
The System was more generous this time around. Zheng Ren was dumbfounded by the mission. Its rewards were unbelievable. He did not know what the silver chest contained but the 300 skill points and 30000 experience points were enough to entice him.
However… Zheng Ren cursed. The System Shop had no central venous catheterization training.
‘Are you f*cking kidding me?’ Zheng Ren thought.
Every wasted minute, no, every wasted second could cost the patient’s life.
Suddenly, the panicking Zheng Ren was blessed with an idea. Interventional surgeries usually started with an artery cannulation, right?
What he wanted to perform was a central venous catheterization, and while they were not the same procedure, the principles were similar.
Why not give it a try?
There was no time to debate the matter. Zheng Ren selected the interventional surgery training module and out came some options, the first of which was vein and artery cannulation.
Without a second thought, Zheng Ren selected it. He was no longer calculative, expending all 14076 of his experience points on intensive training time.
234.6 minutes; not even four hours. That was all the time Zheng Ren could afford.
The System’s operating theater rose from the ground. Zheng Ren entered without further delay. Taking a deep breath to calm himself, he started the intensive training.
Another patient was brought in from the ambulance, in just as severe a condition as the first patient—circulatory shock due to poisoning.
When the patient was pushed into the emergency room, Old Chief Physician Pan had just opened up the first patient’s skin and was separating the subcutaneous tissue to find the semblance of a femoral vein.
“Venous catheterization kit, prepare for disinfection,” Zheng Ren said in a scratchy voice, just waking up.
“Bring in a patient, stat!”
The patient was lifted onto the emergency bed as fast as possible and Zheng Ren got to work.
The patient was in supine position with their feet elevated 15 to 25 degrees above their head to increase venous pressure and blood flow.
This was to ensure venous pressure remained higher than atmospheric pressure, minimizing the risk of an air embolism during central venous catheterization.
Zheng Ren tore open the patient’s top. His show of strength was nearly animalistic. He placed a 500ml water bottle between the patient’s shoulder blades. As they were a tad underweight, Zheng Ren switched the water bottle out with a softer bottle of saline solution.
The aim of the bottle was to open up the chest area, allowing the shoulders to fall back and elevate the section between the clavicles. It would push the subclavian vein nearer to the clavicle and further away from the apex of the lung.
Then, Zheng Ren turned the patient’s head to face him. This placement reduced the angle between the subclavian and jugular veins, making it easier to guide the catheter downward in the direction of the superior vena cava.
“Look here. Make sure the next patient is in the same position.” Zheng Ren wanted to shout the words, but his sore throat made it impossible. The few nurses around him were his only audience.
“Yes!” the nurses replied.
The position was easy, the objective clear. It was not a difficult task.
Gloves went on his hand, a needle at the ready. Once the insertion point was located, Zheng Ren began the procedure.
He did not follow the textbook protocol of subclavian vein catheterization—puncturing one to two centimeters below the midshaft of the clavicle, with the needle angled horizontally and pointed in the direction of the sternoclavicular joint.
Instead, he chose the infraclavicular block as the insertion point, which was below the clavicle and lateral to the midclavicular line.
The nurses had seen subclavian vein insertions before, but the situations had not been as dire and the patients did not have such low blood pressure readings.
Had Zheng Ren lost his senses? Why did he pick the wrong insertion point?
In the midst of the chaos, they did not manage to warn him. Zheng Ren’s hands were steady and quick, and the nurses could only watch as he pressed his left hand on the patient’s chest.
He pressed down onto the skin with his left thumb until it was level with the costoclavicular ligament and marked the point, then removed his thumb and proceeded to puncture the skin there.
All this was curated from thousands of books’ worth of literature regarding subclavian venipuncture and hands-on practice from the System’s intensive training.
During training, all the simulation mannequins had been positioned in the correct way. At first, Zheng Ren completed the procedure in three minutes, which was a bit slow. Toward the end, he could finish with one simulation mannequin in under a minute.
He used 234.6 minutes in the System training to complete 452 venipunctures.
This number might have been lower than some doctors from the emergency departments and intensive care units of larger hospitals, but Zheng Ren had completed them in one go. All the simulations were high-difficulty patients with low blood pressure and low blood volume.
Challenges came with great rewards. Zheng Ren’s phlebotomy skills could be considered among the best in the country.
No one would get the chance to perform hundreds over high-difficulty venipunctures. Only the System could provide such opportunities.
Blood flowed on the first attempt!
It was not standard procedure but the results were evident. The seasoned nurses around Zheng Ren were stunned.
This kind of high-difficulty venipuncture usually took at least five minutes. It involved multiple punctures and maneuvers to find the vein, seemingly dependent on luck. Five minutes to get into the vein was for experts.
Yet, how long did Chief Zheng take? Excluding the time it took to position the patient, it had been only two minutes. No, not even two minutes, one minute…or less. In the blink of an eye, venous blood was seen to flow out.
“Fix an IV line and administer the methylene blue.” Zheng Ren held the catheter and raised his voice when he saw no one following up with the next step.
He could not shout as his throat was totally wrecked. The previous panic-induced a release of epinephrine and dopamine in his body, keeping him in an excitatory state.
“Oh! Oh! Oh!” The nurses around Zheng Ren woke from their stupor, took the venous catheter and connected it to the infusion tube.
“Maximum flow rate. Once the infusion is done, continue with the glucose solution. Then, perform a gastric lavage,” Zheng Ren instructed.
“Yes!” replied the seasoned nurses in unison. They were from other departments but had been reassigned to face the emergency.
He allowed the nurses to administer the treatment and went to position the other patients.
Zheng Ren took the needle and thread from the catheterization kit and started to secure the subclavian vein catheter.
He moved without delay as if under an army general’s command.
Once the stitches were done, he watched the glucose and methylene blue solution drip in the drip chamber. Only then was he reassured.
The next patient was already positioned for the procedure. Zheng Ren took off his gloves and rubbed his hands with an alcohol-based sanitizer. He opened the catheterization kit, put on a new pair of sterile gloves, and got to work.