Chapter 10 — Emergency Night Watchman

The second person: female, about sixty years old, scalp was widely torn, lost consciousness. On the head—【Intracranial hemorrhage. Death countdown: 2 hours.】 Third person: male, over twenty years old, with multiple fractures in his limbs but conscious. On top—no words. Short term is not life-threatening. Fourth person: female, over thirty years old, chest compression injury, respiratory failure. Above head—【Tension pneumothorax. Death countdown: 8 minutes.】 Eight minutes. I rushed forward. Her entire left chest was disproportionally bulging, her trachea was deviated to the right, her jugular veins were distended, her lips were dark purple. Classic tension pneumothorax. You don't need any equipment to diagnose.
“Who has needle number 14?” I shouted.
An emergency nurse next to me threw me a large needle. I tore off her left shirt and touched the midclavicular intercostal space— Insert the needle.
“Pss—”
A stream of air shot out from the end of the needle, the sound of pressure releasing echoed clearly in the chaotic hall. Her breasts began to return to balance. The trachea is slightly misaligned. Respiratory frequency decreased from more than forty times to more than thirty times. No more waiting time.
"This patient needs closed pleural drainage! Who's here?"
"I'm here!" An emergency surgery resident rushed over, “I'm taking over—”
"Okay. After the drainage is closed, transfer to the surgical ICU, suspected of having a mobile rib, pay attention to preparing the ventilator."
I gave him my position, turning to the first red card—the man with an open stomach wound. 47 minutes. He needs emergency surgery, which is not something I can handle.
"This person needs emergency abdominal surgery! Have you contacted general surgery?"
“Contacted, on the way!” The sorting desk responded.
“Have you prepared the blood yet?”
“Four-unit group O red blood cells, plasma—”
"Not enough. Prepare eight units of red blood cells, four units of plasma. His blood loss is more than a thousand milliliters."
I said as I squatted down to examine his abdomen, my hand probed in—I felt there was fluid in the pelvic cavity, there was pulsating bleeding in the spleen area, the protruding intestine was the small intestine, the color was still good, not necrotic.
"Open two large IV lines! Start pressure blood transfusion! Wait until the general surgeon arrives and push him straight into the operating room!"
After dealing with him, I turned to the second person—the old lady with intracranial hemorrhage. Count down two hours for a buffer.
“Where is the neurosurgeon on duty?”
“Already called, I'm on the operating table and can't get off, say in twenty minutes!”
"Mannitol infusion first to lower intracranial pressure. Have you had a CT scan yet?"
“Not yet—”
"Now send it away! Open the emergency blue channel! Tell the CT department to interrupt the brain scan!"
I coordinated the direction of these seriously ill patients, my throat screaming until it was hoarse. Not knowing when, there was another person behind. I don't know when he came from. Waiting until I finished arranging the transfer of the last red-tagged injured person and turned around to take a sip of water, I saw Phuong Chinh Thanh standing next to the triage table, both hands in her blouse pockets, looking at me. I don't know how long he's been looking. My breath stopped.
“Headmaster Phuong… when did you come from…”
“Ten minutes ago.” His face was expressionless, "When I arrived, you were inserting a needle for that pneumothorax."
“I…”
“Continue.” he said.
“What?” "What you're doing, continue. I'll watch."
He actually stood there looking, not moving a step. For the next twenty minutes, I continued to handle the group of wounded soldiers with yellow tags brought to the second phase—fixing broken bones, cleaning wounds, and sorting those who needed to be hospitalized to each specialty. There are a few patients with words on their heads, but they are all counting down in hours or more, not the most urgent matter for the time being. I sort them by severity, dealing with each one individually. Until the last patient is wheeled away. The emergency room is quiet. There were still blood stains and broken glass on the ground, and the air was filled with the smell of disinfectant and rusty iron. I stood with my hands on the wall for a while. Legs are a bit soft. Phuong Chinh Thanh came over.
"Twelve wounded soldiers, you were there for thirty-eight minutes. The classification was without error. If that case of tension pneumothorax had been treated two more minutes later, the heart would have stopped beating."
I opened my mouth to speak.
“I originally went to the Emergency Department today to talk to hospital leaders about expanding the EICU.” He interrupted me, "Just happened to encounter this."
The way he looked at me was different from the first time he looked at me in the teaching room a month ago. When it comes to evaluation. Now it's confirmation.
“Tham Yen, do you know why I brought you here?”
“… Because of that surgery?”
“Not quite.” He said, "I've worked in the Emergency Department for twenty-five years. I've met thousands of attending physicians. Do you know what the most important qualities of a good emergency physician are?"
I shook my head.
"It's not knowledge—that can be learned. It's not technique—that can be practiced. It's judgment ability. In chaos, when information is incomplete, when no one gives you instructions, can you make the correct decision in the shortest time?"
He stopped for a moment.