Chapter 7 — Emergency Night Watchman

“Bromadiolone.” I said, "Second-generation anticoagulant rat poison. It will lead to comprehensive depletion of vitamin K-dependent coagulation factors, the main manifestations are INR explosions, bleeding in organ systems. If this is the case, high doses of vitamin K1 plus intravenous injections of vitamin K1 plus fresh frozen plasma to supplement coagulation factors are needed."
Trinh Duc pushed his glasses: "Where is the base?"
"INR greater than 10 but normal fibrinogen, normal platelets—not like DIC. DIC should be total consumption, low fibrinogen, low platelets. She just has a collapsed coagulation pathway, platelets and fibrinogen still present. This is more like pure vitamin K antagonism."
Trinh Duc was silent for a few seconds, his eyes scanning back and forth on the test form.
“…What you say seems to make sense.”
"Furthermore, she is thirty-two years old, has no history of liver disease, does not take warfarin, has a sudden blood clotting disorder—the possibility of poisoning is very high. You can try an injection of vitamin K1 first to see the reaction, and send for toxicology tests."
"Using experimental drugs? This... Headmaster Phuong is not here, I have to ask for some instructions."
He picked up the phone to call Phuong Chinh Thanh. Phuong Chinh Thanh's phone rang four or five times before picking up.
"Trinh Duc? What's going on?"
Trinh Duc recounted the situation, then said: "Shen Yen suspects bromadiolone poisoning, suggests trying vitamin K1—" The other end of the line was silent for a moment.
“Shen Yen is next door?”
"Here."
“Give her the phone.”
I take it.
“Director Phuong.”
“Why do you think about rat extermination?”
"The INR is explosive but the fibrinogen and platelets are normal, not suitable for the consumption pattern of DIC. Pure coagulation factor deficiency, the most common exogenous cause is vitamin K antagonists. She is young, has no liver disease, is not taking anticoagulants—the remaining option is poisoning. Rat poison is the most common vitamin K antagonist poison."
"YES." There was a hint of satisfaction in his voice, "You're right. Treat it this way. First, give 10 milligrams of Vitamin K1 by slow intravenous injection, and at the same time infuse FFP to regulate blood clotting. Tell Trinh Duc that I agree. In addition—contact her family and her unit, investigate clearly the source of the poison. This kind of thing, if it's not suicide, it's murder."
“Clear.”
Hang up the phone. Trinh Duc heard Phuong Chinh Thanh's instructions and quickly began giving orders. I took the nursing notebook and marked a line: Bed number nine, suspected bromadiolone poisoning. Then contact the patient's unit. An hour later, the vitamin K1 injection was completed. Two hours later, check the INR again—from greater than 10 down to 6.2. The direction is right. Trinh Duc breathed a sigh of relief, his eyes looking at me changed.
“Tham Yen, how did your brain grow?”
I didn't answer, because I saw the countdown on top of the nightstand to nine dragging on. From four hours turned into twelve hours, then turned into twenty-four hours. Finally, the words slowly faded and disappeared. Out of danger. At two o'clock in the afternoon, people from the patient unit arrived. Is her direct manager. The police also arrived. Because of our report—unknown poisoning, suspected poisoning. Later, I heard about what happened next: that woman's husband continuously abandoned a certain amount for a month Drop the rat poison bromadiolone into her glass of water. The dose is not large, a little each day, chronic accumulation, until that day the blood coagulation system completely collapses. Is intentionally killing people. If we hadn't judged that she was poisoned by rat poison and treated her according to normal DIC, she would have suffered from a series of ineffective emergency measures, both internal bleeding and exhaustion of the last clotting factors. The cause of death will be written as “multiple organ failure, cause unknown”. The husband will receive the insurance money. A perfect crime. The day Phuong Chinh Thanh returned from the province, Trinh Duc reported this matter to him. After listening, Phuong Chinh Thanh, his face expressionless, only said one sentence: "What's the use of me coming back? Tham Yen has already done my job." Trinh Duc smiled wryly. Phuong Chinh Thanh looked at me. Not the angry look. It's the type of certainty—“I certainly didn't see the wrong person.”
“Starting from tomorrow.” He said, "In addition to beds number three and number seven, bed number nine is also managed by you. In addition—next week there will be a hospital-wide emergency case discussion, this case you will report. PPT will do it yourself."
Hospital-wide case discussion. The medical examiner makes a report. This is unprecedented. 【Chapter 5】 Hospital-wide emergency case discussion. The meeting room seats more than forty people. Emergency Department, Cardiology Department, Intensive Care Department, Laboratory Department, Pharmacy Department, Neurology Department... every department has representatives. The person standing on the podium is usually a doctor at the primary treatment level or higher. Today the person standing up there is me. Blouse sleeves rolled up to the elbows, the first page of the PPT lit up on the large screen behind—
“A case of coagulation dysfunction due to bromadiolone poisoning”
Reporter: Tham Yen, attending physician of the Emergency Department. I can feel the difference in the dozens of eyes below.