Wu Ting followed the resident physician, Luo Ming, to continue her shift for the day.
Fan City First Hospital operated on a three-tiered on-call system. The first-tier staff—resident physicians and the chief resident—were on duty for 24-hour shifts.
The second tier was composed of attending physicians and above, while the third tier included associate chief physicians and above. Under normal circumstances, second and third-tier physicians were not present in the emergency department.
The emergency department of City First Hospital was divided into internal medicine and surgery teams, each with its own lead. The department was staffed by three internists, five surgeons, and one OB-GYN.
Overall, the department was very well-equipped. The ER had a team of full-time physicians. An emergency physician like Luo Ming had at least three years of clinical experience and was proficient in independently performing CPR, central venous catheterization, arterial puncture, cardioversion, and managing ventilators, blood purification, and trauma resuscitation.
Even the nurses were dedicated ER staff, each with over three years of clinical nursing experience.
Therefore, a resident trainee like Wu Ting was, under normal circumstances, just there to follow doctors like Luo Ming, learn, run errands, and gain experience during her shifts. She wasn't expected to be of much use when a real emergency patient came in.
Luo Ming was very hands-off with Wu Ting's supervision. The ER wasn't too busy tonight, so things were relatively relaxed.
Besides Wu Ting, there was another young doctor, an intern who had just started his ER rotation. It was his first day on shift, and Luo Ming began explaining things to him:
"Our emergency department here at City First Hospital is divided into a Medical Zone and a Support Zone."
"The Medical Zone includes the triage station, consultation rooms, and treatment rooms, which are the areas we use most often. Of course, we also have procedure rooms, a resuscitation room, and an observation ward. As a top-tier general hospital, we have our own emergency operating room and emergency intensive care unit."
"As for the Support Zone, that includes registration, various auxiliary examination departments, the pharmacy, and the billing office."
The young doctor held a notebook, diligently taking notes. He clearly wanted to make a good impression on Luo Ming.
Luo Ming then pointed to the directional markings on the floor:
"This is the in-hospital emergency 'green channel,' connecting us to the operating rooms, the intensive care department, and so on. It allows for a seamless transition between our ER medical care and pre-hospital emergency services..."
"The resuscitation room has a temporary triage station and resuscitation beds. It's fully stocked with emergency medications, instruments, and life-saving equipment for CPR and monitoring..."
"These are the observation beds. They're for patients who need temporary observation in the ER. As a rule, patients shouldn't be kept for observation for more than 72 hours..."
Just as Luo Ming was explaining this to the new intern, chaos erupted at the ER entrance. Several workers, shouting frantically, rushed in carrying a man.
"Dr. Luo," an emergency nurse cried out, "we have a patient with a traumatic brain injury, respiratory distress, and a severe neck injury with bleeding and swelling!"
An emergency nurse shouted.
Luo Ming tensed up. He had just finished explaining what the resuscitation room was for, and now a patient this critical had arrived.
As the first-tier doctor on duty, Luo Ming rushed over immediately.
The new intern was clearly flustered, having never witnessed such a scene before.
Wu Ting, however, had been on many shifts. She followed Luo Ming directly to assess the patient's injuries.
"Doctor, you have to save our Brother Luo! Old Luo is a construction foreman on our project. We were pouring concrete tonight, and he accidentally fell from the scaffolding."
"He landed head-first on the concrete. He wasn't wearing a hard hat or a safety harness..."
The coworker beside him was filled with regret. It was nighttime, so Old Luo had figured there wouldn't be any clients or supervisors making rounds and had let his guard down. Who knew that one moment of complacency would cause him to fall from the scaffolding?
After hearing the coworker's account, Luo Ming's expression grew grave as he looked at the patient's condition.
"Get him to the resuscitation room, now! He has obvious shortness of breath, cyanosis of the lips and nail beds, loss of consciousness..."
This was a race against time. Thankfully, his coworkers had brought him in quickly.
Luo Ming followed the patient to the resuscitation room with Wu Ting right behind him. The new intern, his heart pounding, tagged along at the back. But seeing how busy Luo Ming and the nurses were, he had no idea what to do, and no one had time to pay him any mind.
Watching Wu Ting, who was also a junior doctor, follow calmly and even begin preparing to assist, the intern felt a mix of envy and surprise.
The patient was quickly moved onto a bed in the resuscitation room.
The emergency nurses simultaneously hooked him up to the monitors.
"Dr. Luo, the patient's condition is critical. His blood oxygen saturation has dropped to 70%! We're giving him 100% oxygen, but the arterial blood gas analysis indicates severe Type II respiratory failure..."
"The patient is unconscious with laryngeal edema! He could suffocate and die at any moment!"
The emergency nurse was growing frantic.
Luo Ming started to panic. "Contact the second-tier attending, Qin Donglai, immediately! And notify Director Huo! Ask them how long it will take for them to get here."
As a senior resident, Luo Ming knew from the patient's terrible vital signs that this was beyond his ability to handle alone. He immediately sought help from Qin Donglai and Huo Yun.
A nurse at his side immediately got Qin Donglai on the phone.
"Dr. Luo, Dr. Qin is on his way, but it will take him at least ten minutes."
At the same time, another resident physician on the side got ahold of Huo Yun.
"Dr. Luo, Director Huo was at a conference today. He's on his way now, but it'll be over half an hour at least..."
Hearing this, Luo Ming looked at the patient's condition, and his face darkened.
"There's no time! The patient can't wait. If we don't do something urgently, at this rate, he won't last five minutes."
Luo Ming thought for a moment. "Alright, we'll perform an emergency endotracheal intubation immediately. At the same time, transfer the patient to the ICU! We'll wait for Dr. Qin to arrive."
Hearing Luo Ming's orders, the emergency nurses began to move.
Both endotracheal intubation and tracheotomy are common methods for assisted breathing. Comparatively, intubation is less invasive and is generally used on patients who are unconscious or under anesthesia.
Of course, Luo Ming had his reasons for choosing intubation. It was a relatively simpler procedure, one he was capable of handling. A tracheotomy, while more effective, came with significant risks—especially the high chance of postoperative pulmonary infection. He couldn't bring himself to make that call.
'I'll just use intubation to relieve the asphyxia for now.'
However, just as Luo Ming was about to begin, a hand pressed down on his.
"Dr. Luo, I don't think intubation is appropriate for the patient's condition anymore. I recommend we perform a tracheotomy. Intubation is simple and easy, but with his severe laryngeal edema, it will be difficult to provide nursing care and won't be conducive to suctioning."
Luo Ming turned his head and was slightly taken aback by the serious and resolute look in Wu Ting's eyes.
He knew she was right, of course.
"It's just... the risks of a tracheotomy are too great. And there's no guarantee we can prevent a postoperative pulmonary infection. I... I'm not confident..."
Hearing Luo Ming's explanation, Wu Ting calmly patted his arm and said with conviction:
"Dr. Luo, I know how to perform a Tracheotomy. I can do it."
"What's more, I have a surgical plan that can solve the problem of potential postoperative lung infections."
As Wu Ting spoke, the emergency nurse shouted again:
"Dr. Luo, the patient's condition is dire! He's in cardiopulmonary arrest! If we don't establish an artificial airway now, the oxygen supply to his heart, brain, and other vital organs will be compromised!"
"We need to operate immediately!"