When the Doctor Uses A Hack

What worried him was not knowing how much longer the patient could hold on and whether they could make it to the hospital.

After all, pericardiocentesis…

Right!

Chen Cang suddenly remembered that he possessed a pericardial skill package.

[Pericardial Skill Package: After opening, you can choose to acquire a pericardial skill.]

Chen Cang gritted his teeth and hastily selected [Emergency Pericardium Puncture Catheterization].

To tell the truth, mastering this skill made Chen Cang feel like he was at a loss.

After all, the pericardial skill package contained a variety of pericardial surgical procedures, including pericardiotomy, pericardial repair, and so on…

These are all tier-three surgeries.

By comparison, pericardiocentesis is merely a tier-two puncture operation.

Although it’s a bit more complex than thoracocentesis, peritoneocentesis… these four major punctures, it ultimately is still a puncture technique.

But… with the situation being so urgent, Chen Cang had no time to hesitate and directly chose to learn!

[Ding! Congratulations, you have learned Emergency Pericardium Puncture Catheterization. Would you like to start training now?]

At that moment, Chen Cang didn’t have the luxury to hesitate and immediately chose to enter!

The greatest risk of pericardiocentesis compared to thoracentesis is that if the needle mistakenly enters the ventricle, it could cause big trouble!

After all, the pericardium is not as thick as one might imagine!

And the heart is not as sturdy as one might think.

Maybe… this puncture, far from alleviating the patient’s condition, might exacerbate the symptoms, or even cause death.

A change flashed before Chen Cang’s eyes, and he was suddenly in the familiar environment of an operating room.

After entering the training space, he began to simulate, learn, and master the indications for pericardiocentesis, the conditions for pericardiocentesis…

He trained continuously, practicing punctures under ultrasound guidance… adjunctive punctures… punctures under cardiac monitoring…

Until at last, Chen Cang began blind punctures.

This was the most crucial step!

It was to perform pericardiocentesis with the puncture needle without any auxiliary equipment.

Obviously, given the situation at the scene, there was no other choice but to perform a blind puncture!

Time ticked by, and Chen Cang’s proficiency grew steadily.

But in the end, he never achieved one hundred percent certainty.

This left Chen Cang feeling very uncertain.

The puncture training was comprehensive.

It even included the emergency management conditions for pericardial puncture.

For instance, pericardial effusion does not always require immediate surgery but has an accurate scoring standard. Some require urgent puncture, while others need to be done within 12 to 48 hours.

Not all pericardial effusions are better off treated sooner.

In the virtual space, Chen Cang continuously learned and disseminated techniques and knowledge related to pericardial effusion and pericardiocentesis.

Soon, the training time ended.

This was the first time Chen Cang felt his special training time was so fleeting.

He truly wanted to perfect this technique and practice the “blind puncture” success rate to one hundred percent, to provide better and more accurate treatment for the patient.

Unfortunately, things often do not go as wished…

Soon…

After Chen Cang exited the virtual space, a notification tone rang out.

[Ding! Emergency Pericardium Puncture Catheterization: Master Level; Special effects: 1. Precision; 2. Safety.]

The two special effects were very important to Chen Cang.

These were also the two areas Chen Cang had focused on practicing continuously in the virtual space.

First, it was essential to ensure that the location of the pericardiocentesis was precise, and secondly to ensure absolute safety during the puncture process.

…

At this moment, outside, less than a second had passed.

This second was very short, but for the patient at this moment, it could mean the difference between life and death.

Chen Cang quickly used the knowledge he had learned to assess the patient’s condition.

Seeing Chen Cang hesitate, Old Liu urgently said, “Doctor Chen, let’s hurry up and go! Take him to the hospital, we can talk more when we get there, alright?”

Chen Cang shook his head, “It’s too late, the patient is in a very critical condition now, there is too much fluid accumulated in the pericardial cavity, seriously affecting blood circulation. If we don’t drain it, I’m afraid we won’t even make it to the hospital!

Even if we did get to the emergency room, who knows what the situation would be? He needs emergency pericardiocentesis now!”

Upon hearing Chen Cang’s words, Old Liu immediately shook his head!

This young Chen was too impulsive.

Having been a 120 ambulance driver for twenty years, Old Liu was very familiar with such situations.

What is pericardiocentesis?

He naturally knew what it entailed.

But it was precisely because he understood that he was even more worried.

What are the conditions at the scene?

Nothing!

No CT imaging, no echocardiography for location, cardiac monitoring couldn’t be brought online!

What are you going to use to do it?

A blind procedure?!

Do not think that drivers of 120 emergency vehicles are just drivers. They have seen as much life and death as the doctors and witnessed numerous rescues. Thus, upon hearing Chen Cang’s words, they immediately became anxious and uneasy.

“Are you sure we can’t make it to the hospital, Old Liu?” the driver still asked with some concern.

Chen Cang nodded, “We can’t hold out. The heartbeats are getting weaker by the moment; if we wait until we get to the Second Provincial Hospital, the person might already be gone!”

Not draining the fluid puts such a massive burden on the heart that nothing you do will help.

Relieving the pressure on the heart is the patient’s only chance of survival.

But how should he proceed, given the patient’s limited condition to perform puncture location and explore cardiac structures?

If there is no ultrasonic positioning, the doctor must rely solely on their tactile sense and experience, which might result in a failed puncture or even worsen the condition. Moreover, since the cause of bleeding is unknown and the extent of internal cardiac damage is unclear, could the puncture cause uncontrollable hemorrhage due to cardiac rupture? Or would it render the pericardiocentesis ineffective, even accelerating the patient’s death?

Was there time for a traditional emergency thoracotomy to explore and stop the bleeding?

This wasn’t about whether it was allowed, the conditions simply weren’t met!

There wasn’t enough time!

A slew of thorny issues lay before Chen Cang, and with the patient’s life hanging by a thread, he couldn’t afford to ponder any longer. The chance to snatch a life back from the grips of the Grim Reaper was fleeting, this one time only!

Emergency Pericardium Puncture Catheterization!

Chen Cang made up his mind, deciding that he must race against the clock to rescue this glimmer of hope.

If the patient didn’t undergo pericardium puncture, it wasn’t just a question of whether the rescue could succeed, they wouldn’t even make it to the hospital.

Not to mention diagnosing and understanding what the problem was.

Nevertheless, emergency pericardium puncture catheterization could quickly address the life-threatening issue of cardiac tamponade—the most crucial step, as it was vital for both immediate survival and for buying time for subsequent rescue efforts.

Chen Cang opened the emergency kit, no pericardium puncture needle was inside, but there was a pleural puncture needle.

Either could be used.

Lao Liu looked anxious and apprehensive, watching Chen Cang, “Dr. Chen… are you going to…”

“Blind puncture?”

Chen Cang nodded. What other methods were there without a blind puncture?

None!

He had to perform a puncture.

After cutting open the clothes and disinfecting, Chen Cang began his operation.

Chen Cang suddenly wished he had X-ray vision. Wouldn’t that be great?

Not for anything else but to increase his chances of success during the puncture!

Anxiety!

Unease!

All these emotions filled Chen Cang’s heart.

There was only one chance.

Chen Cang took a deep breath, the puncture needle slowly penetrating as he needed to feel every bit of sensation, that empty feeling as it broke through the pericardium.

Chen Cang proceeded slowly.

Everyone around him didn’t dare to make a sound.

Lao Liu was even more still, not daring to disturb in the slightest.

Muttering to himself in his mind.

Had he ever seen such a blind puncture before?

He had!

But they’d all bloody failed!

Bloody hell.

Thinking about it, Lao Liu felt a surge of fear.

He followed Chen Cang’s every move with trepidation, terrified something might go wrong.

Chen was… really bold!

The stifling environment made it hard to breathe.

But for Chen Cang, it was the cold sweat on his back that he felt!

Please, let nothing go wrong.

Suddenly, Chen Cang felt the puncture needle give way, he stopped as soon as he felt it.

His deft hands allowed for a swift response.

Chen Cang said to Lao Liu, “Draw some for me, I want to see what fluid it is.”

Lao Liu nodded hastily, “How much should I draw?”

Chen Cang shook his head, “First draw back a few milliliters, let me see the situation.”

After repeating his instructions, Chen Cang shook his head again, “I’ll do it myself.”

Lao Liu gave an embarrassed smile, somewhat ashamed.

Chen Cang didn’t mind; after all, Lao Liu wasn’t a doctor, and drawing back required skill, you couldn’t pull too hard, in case you drew from the heart…

Chen Cang drew back slowly, facing no resistance.

He was relieved…

After 5 milliliters came out, Chen Cang saw it was all blood.

His face changed instantly.

This wasn’t good news.

Blood vessel rupture? Or heart damage?

All were possibilities.

Chen Cang continued to draw.

Feeling the resistance from the syringe, he gently withdrew.

After about 100 ml, Chen Cang didn’t dare to draw more.

He removed the puncture needle, picked up the stethoscope to begin auscultation, and felt that the heart sounds had recovered, and the heartbeat was becoming stable.

Chen Cang was instantly excited.

It was a success!

The pericardium puncture was successful.

Chen Cang, feeling the gradual recovery of the patient’s vital signs, rejoiced inside.

At least the patient had taken the first step!

In other words, they had defeated the first boss blocking the patient’s road to successful treatment!

Cardiac tamponade!

However, this didn’t mean the patient was out of danger.

Because the underlying cause of the pericardial effusion was still unclear, they must hurry to the hospital for the next steps of the rescue.

“Lao Liu, prepare to lift onto the ambulance, to the hospital!”

Once Lao Liu heard this, he instantly understood the situation and quickly, with Chen Cang, carefully lifted the stretcher towards the emergency ambulance.

…