Chapter 579: Shock Chapter 579: Shock A group of people helped to carry and lift the injured women and children and transferred them to the outpatient building first. Other victims would be rescued by the firefighters after they managed to break through the debris. At the outpatient building, it was nearing noon, and the doctors who had been seeing outpatients had left, leaving only two elderly nurses on duty. No wonder there had been difficulty finding doctors to help after the accident occurred.
Upon hearing that doctors were present, the two elderly nurses opened the doors to let them bring the injured in.
Although it was an outpatient clinic, there was a treatment room available. Some emergency supplies were on hand, just in case they would be needed. They proved useful now.
“Get a blood pressure cuff and measure the blood pressure.”
“Start with an IV. There’s blood loss.”
After a brief argument between the two nurses, they turned to ask the doctor, “Should we start with an IV drip of saline?”
“Yes, draw some blood while you’re inserting the IV, in case it becomes challenging to take blood later,” Xie Wanying responded, also looking at the counselor.
Ren Chongda did not object to her suggestion, indicating his agreement with her instructions.
The elderly nurses went to get blood drawing and IV kits. The treatment trolley was quickly brought over to start on blood draws and IVs for the child and the woman.
Both patients were losing blood and showed symptoms of low blood pressure; their veins were difficult to locate, making it challenging to place the IV. The two elderly nurses squinted through their presbyopia, straining to find the patients’ veins. They were older and had been relegated to a secondary role, which is why they were assigned to work in such an outpatient clinic. They almost never encountered emergency rescue situations on regular days.
“No good, can’t get it in, doctor,” the nurse reported.
At this time, the patients’ peripheral vasculature was experiencing low perfusion, with reduced arterial blood output and venous return, causing the blood vessels to become constricted and shrunken. The preferred method would be a central venous catheterization, like the subclavian vein puncture Xie Wanying had performed previously. The issue was that the outpatient clinic might not have the required needle for such a puncture.
Hearing the nurse’s report, Xie Wanying had anticipated this. She turned the patient’s head and saw a slightly distended external jugular vein. She turned back to ask Teacher Ren, “Teacher Ren, shall we insert a needle in her external jugular vein?”
“Sure,” Ren Chongda replied without hesitation, leaving her to handle it. He urgently needed to figure out how to solve the acute brain herniation in this boy.
Compared to Mother Dongzi’s abdominal bleeding, Dongzi’s intracranial hemorrhage was more acute and left even less time for doctors. Abdominal bleeding wouldn’t immediately compress the patient’s vital physiological organs. It was possible to maintain vital signs with fluid resuscitation for a short time. An acute brain hernia, on the other hand, was different. Continued heavy bleeding could quickly form a hematoma, compressing the patient’s brainstem, which is vital for life; death was inevitable without intervention.
Seeing Teacher Ren’s response, Xie Wanying knew she had to insert the IV quickly for Mother Dongzi because Teacher Ren would definitely need her assistance soon. When both elderly nurses heard she was going to attempt the external jugular vein, they agreed with her idea but expressed concerns about their own failing eyesight, asking her, “Can you do it?”
“I’m a medical student, I’ve learned how to insert needles from a nurse,” Xie Wanying said.
The IV catheter was brought over, and the area around the conventional puncture point was quickly disinfected over a larger area. One nurse placed a small, soft pillow under the patient’s shoulder to elevate it.
Unlike puncturing peripheral veins in the limbs, where a tourniquet or rubber band is typically used above the puncture site to fill the veins for visibility, there is no such location available for the external jugular vein to be bound for the person administering the IV. The person had to use fingers to press down on one end of the external jugular vein over the clavicle to make the segment as full as possible for easier needle insertion.
Xie Wanying put on gloves on both hands.