(Thanks to the book friend 20191123092721288 for the reward and encouragement, and also to Lang Ru Tie 83, book friend 20181026144910683, Wang Lintai 1, book friend 20180728135128618, Piao Fu Ban Sheng, Fei Tian Yao, Zi Xing 87, Kan Shu Dao Chai, Hei Ba Tian Xiong, book friend 20190702214806179, Manchester Duke, Harmony Brother, book friend 20180228003957937, Joy Brother, book friend 130120121016798, Jing Ya Xiao Qi, Say Goodnight for their monthly ticket encouragement)

For night shift doctors, if there are not too many patients visiting, it's quite good. When there are no patients, at least you can sleep.

But for night doctors in large hospitals, this season is really not friendly. The drunkards keep coming one after another, occasionally mixed in with patients from brawls.

This covers a wide range of ages, from teens to those in their dozens, but once they've had a drink, many times they'll forget their age.

However, for Liu Banxia, there's basically not much to do at the moment. Just sitting here with Qi Wentai is enough, with six small ones and four interns, it's enough to handle the situation.

"Teacher Liu, here are the latest test results for that patient. Myocardial infarction pain has been ruled out, but his creatine kinase is over 5000, suspected to be rhabdomyolysis caused by excessive drinking," Miao Rui said, handing over the latest test report.

Liu Banxia took a glance at it, "Arrange dialysis immediately, and contact his family. I see there's an indication of acidosis here; although it's not too severe, it still needs to be noticed."

"His blood sugar is a bit low, which contradicts ketoacidosis a bit. Adjust electrolytes, dialysis, insert a urinary catheter. If delayed, his kidney may not fare well."

Miao Rui nodded and hurried to make arrangements.

In the past, this kind of situation would have required sending the patient to the ICU. But now with the urology department, related procedures can be handled.

Liu Banxia continued to study the latest test results for the patient. He was still puzzled by the patient's low blood sugar and the pain symptoms.

Some people have sensitive insulin secretion that increases after excessive drinking. But such patients are rare; more commonly, there's suppression, causing blood sugar to rise.

With elevated blood sugar, the condition aligns with alcoholic ketoacidosis.

From the current patient's situation, it should belong to metabolic acidosis.

Of course, it might also be because the patient drank a lot without eating much else, or vomited after eating before it could be digested.

The reasons vary, but the most urgent thing right now is kidney protection. Rhabdomyolysis can cause severe damage to the kidneys.

This issue at least has some threads to follow, but the pain complaint from the patient leaves him completely without a sense of direction.

It could be a manifestation of drunkenness, or it could be true pain somewhere, which could become very dangerous.

Liu Banxia firmly believes that any sensation of pain means a certain symptom exists. It's precisely this disease that causes the nerves to transmit pain signals.

Liu Haibing's friend had a long history of high blood pressure and an aortic dissection after drinking. With this patient, he's really finding it hard to judge.

"President Qi, just reported the latest test results of the patient I talked about. It's diagnosed as rhabdomyolysis and acidosis, currently adjusting electrolytes and dialysis," Liu Banxia said as he approached Qi Wentai.

"It really has gone up, has the family been contacted?" Qi Wentai asked.

"I've already told Miao Rui to contact them. We haven't sent him to the ICU, just handling it downstairs," Liu Banxia said.

"But I'm always skeptical about the patient claiming pain. I can't determine if he's truly in pain or not; his drinking buddy is still asleep, hasn't sobered up."

"What do you suggest we do next? Suspect an aortic dissection? Didn't you have a patient like that before?" Qi Wentai asked.

Liu Banxia nodded, "Some suspicion, but right now it doesn't seem very likely. Plus, we primarily need to ensure his kidney and correct the acidosis, let's see."

"Alright, then this patient is directly assigned to you," Qi Wentai said.

This also clarifies responsibilities, as Qi Wentai is the regular attending physician. He can manage the "six small ones," but can't handle Liu Banxia and other attending physicians.

Unlike the previous Liu Banxia, who had significant authority as a chief resident.

Now, this patient must be treated by an attending physician.

As with many emergency cases, he can lead the residents in the initial diagnosis, then allocate patients to different attending physicians.

"I'll go there and check it out, I always feel this patient's situation is quite complex. Call me if anything comes up, and let me know when his drinking buddy wakes up," Liu Banxia said.

"Okay, take care," Qi Wentai said.

In the patient's examination room, Liu Banxia took a glance and sighed inwardly.

The catheter was already inserted, and although the urine in the bag was not much, it had discolored a bit. This is about monitoring timely; although rhabdomyolysis has begun, it's not yet severe.

Ding! Unusual Drunken Patient Task Completed

Gained 200 Experience Points, Glory Points +1

Even though the system announced task completion, Liu Banxia's heart didn't feel at ease because the patient's claim of pain continued to perplex him.

"Teacher Liu, the patient is relatively stable now," Miao Rui said.

"You two just keep an eye on things here. Check again in an hour," Liu Banxia said.

"With dialysis and electrolyte adjustment, it probably won't take an hour for him to wake up. Call me then, I'll talk with him to see if there are any other issues."

Miao Rui nodded, of course understanding what emergency a rhabdomyolysis situation represents. Even though treatment started as soon as it was discovered, it could still become very serious.

Just as he returned to the hall, Qi Wentai waved at him.

"What's up?" Liu Banxia asked.

"A car accident patient is about to be brought in. The driver was drunk, and the injuries are severe. Initial diagnosis shows a fractured sternum and a proximal radial fracture in the left arm," Qi Wentai said.

"Okay, leave it to me. Su Wenhao, get ready for admission, and contact the blood bank," Liu Banxia said.

"Family members, please step aside, and those caring for intoxicated patients, move away. An emergency patient is arriving, make way for the passage."

After Liu Banxia finished speaking, he started changing into disposable surgical attire.

"Teacher Liu, are the patient's injuries very serious?" Su Wenhao asked as he arrived.

"Pretty much, a drunk driver. It's basically a situation where if there's an accident, it won't be a minor one. But it seems no one else is injured, which is good," Liu Banxia said.

Outside, after waiting for less than five minutes, an ambulance and police car arrived together.

"The patient is unconscious, the driver involved in the accident. Blood pressure is 70/90, heart rate 130, fluids being administered onboard. Fracture of the left sternum and proximal radial fracture in the left arm," the paramedic pushing the patient down said.

"Rescue Room One. Book the operating room, connect the ECG and open the IV line after transferring the bed. Administer blood and fluids," Su Wenhao said. 𝕗𝗿𝕖𝐞𝐰𝗲𝕓𝐧𝕠𝕧𝗲𝐥.𝚌𝐨𝚖

"Officer Ma, just this one patient?" Liu Banxia asked, looking at Ma Limin who got off the vehicle.

"There are two more, one died on the spot, and another one was sent to another hospital, fearing an incident," Ma Limin said with a solemn expression.

Liu Banxia frowned, diverging from his expectations.

But this is understandable, otherwise, if all were brought together, the family of the victim might do something drastic out of anger.

He entered Rescue Room One, just as Su Wenhao and the others finished transferring the patient.

"Oxygen saturation 85, blood pressure 65/80, heart rate 120," the nurse quickly reported after connecting the monitor.

"Quickly administer blood and fluids, fast blood tests, call in orthopedics and cardiothoracic. 100 ml of succinylcholine, 20 ml of etomidate, Teacher Liu, we need to intubate immediately," Su Wenhao said.

After speaking, Su Wenhao began auscultating the patient's heart and lungs.

Liu Banxia didn't dare to delay; the patient's oxygen saturation was indeed low, likely due to a lung injury and possibly a hemothorax.

"Abdomen is soft, breathing sounds on the left are weak, chest tube insertion is needed on the left. There's no time for more diagnostics, notify the cardiothoracic surgeon to head directly to the operating room," Su Wenhao said.

"OK, I'm done with the intubation," Liu Banxia said after completing the intubation.

"Oxygen saturation is up to 90 now," the nurse said.

"Looks like it's a hemothorax, probably ribs have punctured the lung. After intubation, get a bedside X-ray," Su Wenhao said while inserting the chest tube.

This is the best examination he could think of at the moment, as the bleeding in the chest cavity seemed quite severe, and it was uncertain if it had damaged a major vessel in the lung.

"Li Tianyang, squeeze the blood bag, hang another blood bag," Liu Banxia said as he grabbed a saline bag in his hand.

The patient's bleeding was much more severe than anticipated, requiring rapid blood and fluid resuscitation to raise the patient's blood pressure.

"OK, chest tube insertion complete. Everyone step back, X-ray," Su Wenhao said.

Upon hearing his words, everyone quickly moved aside.

After the X-ray, they saw that two ribs had punctured the lung.

"Blood pressure is 60/70," the nurse reported.

"Transfer to the operating room immediately," Su Wenhao said.

Ordinarily, an ultrasound of the abdomen and chest would be done to further clarify the condition. However, there's really no time now, not even for vasopressors.

The patient's current condition is severe blood loss, and even rapid blood and fluid resuscitation has not achieved the goal of volume expansion, leading to continuously dropping blood pressure.

The prerequisite for using vasopressors is maintaining sufficient circulating blood volume.

"Once on the table, check the abdomen, and if necessary, call me directly."

As they pushed the patient out, Liu Banxia said to Su Wenhao.

"Got it," Su Wenhao responded.

Ding! Emergency admission completed

Gained 100 experience points, 100 proficiency points in dressing technique, and +1 Glory Point

If the patient's abdomen were rigid, Liu Banxia would have followed them to the operating room. The most critical issue now is the lung bleed, and the abdomen should be fine.

For this patient, success in resuscitation will depend on the skills of the cardiothoracic surgeon. All possible time has been saved, and it's also up to the patient's luck.