Chapter 118: Emergency Room 5 Overcrowded
The orderly was free, so he pushed the cart over and transported the deceased car accident victim to the hospital morgue.
Father Liu glanced at the dead patient and his breathing became rapid. Strangely, however, the heart rate on the monitor showed no significant changes for the time being.
“No beds in cardiothoracic surgery?” Concerned for the little one, Xie Wanying asked her senior.
Cardiothoracic surgery? Upon hearing her question, both Huang Zhilei and Doctor Jiang were somewhat surprised.
“It’s a patient with angina, suspected of having a myocardial infarction, so they’re on the monitor,” Doctor Jiang explained, “The case was taken by the internal medicine department, and they might need to have an interventional stent, but there are no beds available in cardiology.”
While answering, Doctor Jiang guessed that Xie Wanying had learned of the patient’s condition from the diagnosis on the Bedside card. Yet, with the emergency department overflowing today, emergency nurses simply didn’t have the time to place Bedside cards in the resuscitation room.
Having gotten to know his junior sister better last night, Huang Zhilei looked down at the head of the bed to check for a Bedside card but found none. In fact, upon his arrival, he didn’t even know what was wrong with this patient. It was Doctor Jiang, not the emergency internal medicine physician, who had called him in.
“How can we secure a bed?” Xie Wanying asked her senior.
“Getting a bed today is too difficult; we’ll have to wait,” Doctor Jiang replied, highlighting the predicament, “Look at my female patient with gastrointestinal bleeding, from last night she’s been lying there unable to get into our department. She is our department’s patient, and it’s even harder to say for patients from other departments without doctors on duty in the emergency room today.”
The attending physician himself couldn’t manage to get a patient admitted. Xie Wanying immediately thought of Yue Wentong, who was in front of the nurse’s station. The patient the head nurse had taken was admitted by a professor.
“His condition seems alright, he might need to wait a few more days, or he could be directly transferred to the Observation Room for monitoring,” Doctor Jiang suggested, looking at Father Liu’s heart rate and blood pressure on the monitor.
“But with patients , isn’t it more important to determine how many vessels are blocked? Waiting until a large area of the myocardium dies is too late. The gold standard for confirmation of diagnosis is coronary angiography. Moreover, the monitor simulates leads, it’s not as accurate as an ECG machine,” Xie Wanying stated.
Huang Zhilei was taken aback: his junior sister was as blunt as she had been the previous night. Although last night’s issue was neurosurgery, today’s was cardiac disease. Had his junior sister also reviewed knowledge of other departments that weren’t part of the internship program?
In fact, Xie Wanying was somewhat anxious about Father Liu’s condition, hence she directly addressed the seniors in front of her, just like she had the previous night.
After listening to her, Doctor Jiang thought about it and agreed. Some patients with cardiac vascular disease, can maintain a balance of oxygen supply and demand before a heart attack, often showing no significant characteristic changes on the ECG. However, once an attack occurs, their condition can deteriorate rapidly. Some patients can show no signs at all before dying. They may not even experience any chest pain despite their complaints of pain.
“We need to first perform a coronary angiography to see how blocked the vessels are. If that’s not possible, transfer from cardiology to cardiothoracic surgery can be considered,” Doctor Jiang said, no longer insisting on his initial statement, and began to somewhat support Xie Wanying’s idea. He then smiled and asked Xie Wanying, “You’ve studied diagnostic medicine, so which chapters of internal medicine and surgery have you reached now?”
It felt female intern could pinpoint the crux of clinical observation, indicating an expertise that was unusual for a clinical rookie. These insights were not something found in medical textbooks; they belonged to a doctor’s personal clinical experience.