Chapter 18
Chapter 18
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Translator: crow
Chapter Title: Isn't It a Cold? (2)
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Chapter 18
The nurse checked the order and rushed off to fetch the portable EKG machine. I headed back to the bed where the patient was lying.
In the meantime, comments started popping up on the blue interface.
Hippocrates' Heir: O living one, hasty judgments are forbidden. Neck pain could be musculoskeletal.
Anonymous (118.235): Whoa, sore throat lololol yeah, it could be referred pain, but you gotta do the ECG to know.
“Doctor! I got the EKG!”
The nurse began attaching the electrodes with practiced hands.
The patient looked terrified by the sudden commotion.
“Doctor… am I dying? It’s just a sore throat, why is everyone…”
“It’s okay, sir. This is just a routine check. No need to worry. Just relax and stay still for a bit.”
I turned to the nurse.
“Just in case, please bring the crash cart over here ahead of time. Purely precautionary.”
Whirrr—
The EKG machine started spitting out the long strip of paper.
Please, please let it be nothing.
Make me the idiot who overreacted.
But God didn’t answer my prayer.
The moment I took hold of the EKG strip, my hand trembled faintly.
“Fuck…”
The curse slipped out on its own.
II, III, aVF. In the leads showing the inferior wall of the heart, the ST segment was elevated like a mountain peak. Classic inferior wall infarction findings.
I shouted in a panic.
“Let’s do one more lead—V4R!”
V4R.
The lead placed on the right chest to check the right ventricle. Essential in cases of inferior infarction.
Moments later, the additional EKG confirmed my worst fears in stark black and white.
Even in the V4R lead, there was a clear ST segment elevation.
Inferior wall infarction with right ventricular involvement.
Not just a myocardial infarction. The right ventricle—the heart’s auxiliary pump—was failing too.
Giving vasodilators carelessly to a patient like this could tank their blood pressure and send them into fatal shock.
“Aspirin 300mg, Plavix 600mg—have the patient chew and swallow them right now.”
“Yes!”
“O2 at 2L via nasal cannula! And absolutely no nitroglycerin! Blood pressure will crash! Instead, secure another IV line and run 500cc normal saline as a fluid bolus!”
After issuing the initial treatments, I finally caught my breath.
But anxiety flooded in right away. Had I missed anything? What else needed doing in this situation?
I logged back into the gallery. Time for confirmation.
Title: Did I handle this right?
Author: Hell Joseon Slave 1
Inferior with RV infarction. Skipped nitro in MONA and did fluid loading. Now off to PCI? Anything I missed?
Posted.
I pulled out my phone and opened the hospital directory.
Cardiology on-call. Cardiology, cardiology…
As I scrolled frantically, new comments started flooding the gallery in real time.
Cardiology Ghost: Well done. (Dumpling thumbs-up emote)
Anonymous (118.235): Good call on the fluid loading. But did you auscultate the heart sounds? Inferior MIs often come with complete AV block, so prep for that.
God's Scalpel: Are the medics done playing house? That’s cardiogenic shock territory. You prepping ECMO before rolling to the cath lab? What if they code on the table?
Cardiology. Complete AV block. ECMO.
I hadn’t solved a damn thing yet.
Get it together, Han Hyun-jae, you bastard.
I cursed myself inwardly. No time for panic. I needed to call someone to take this patient now.
Cardiology.
[Cardiology - Park Woo-young]
I swallowed hard and hit call.
Riiiing.
Riiiing.
Before the second ring finished, the call connected.
Noisy chatter came through the receiver, along with an irritated voice.
“Yeah, what?”
The clatter of trays in the background.
Staff cafeteria.
‘…Oh man, he’s eating.’
Guilt hit for a second, then another thought flashed.
‘Cafeteria means three minutes flat to the ER. Maybe that’s a good thing?’
I shoved the selfish notion aside and stated my ID and purpose as quickly and precisely as possible.
“Doctor! Hello! This is Han Hyun-jae, first-year EM resident. We’ve got a 54-year-old male with inferior wall MI plus right ventricular infarction, calling for consult—”
Before I could finish, a chair scraped loudly on the other end, followed by a yell.
“What?!?! Infarction?!?! Got it!!!!”
…Click.
The line went dead.
“?”
I stood there blankly, staring at the ended call screen on my phone.
What the hell was that guy?
‘Got it’ what? Coming or not?
What doctor hangs up without asking patient status?
Two seconds later, my phone exploded with incoming calls. Same number—Cardiology, Park Woo-young.
I answered on reflex.
“Hello?”
“Sorry! Sorry! Hey, you forgot to tell me the important stuff!”
A frantic voice poured through, accompanied by the harsh breathing of someone sprinting down a hall.
“Patient status? Give me the basics! I’m running over—talk while I move!”
‘Yeah, infarction call would make anyone drop their spoon and bolt.’
I swallowed a wry chuckle and mobilized every scrap of knowledge the ghosts had drilled into me yesterday, plus my own recent decisions, for the report.
“Yes, Doctor. 54-year-old male presented around noon with severe sore throat. Initially triaged as KTAS 5 suspecting cold, but the pain intensity didn’t match exam findings, so I suspected cardiac and proceeded with workup.”
“Sore throat? Not chest pain?”
“Yes. Burning pain radiating to jaw and neck primarily.”
“Got it, go on. Vitals?”
“Current vitals: BP 90/60, pulse 55, RR 22, SpO2 98%. BP and pulse trending down since arrival.”
“EKG?”
The breathing grew even rougher.
“12-lead just done: 3mm ST elevation in II, III, aVF. Reciprocal ST depression in I and aVL. Right-sided EKG for RV infarct suspicion shows 2mm elevation in V4R, so diagnosing inferior MI with RV involvement.”
“Initial management?”
“Post-EKG, patient alert, so chewed and swallowed aspirin 300mg and Plavix 600mg. O2 at 2L nasal cannula ongoing. No nitro due to RV infarct; fluid bolus with 500cc NS for BP support. Cardiac markers pending.”
Finally, I slipped in the gallery ghosts’ advice.
Naturally, like it was my own call.
“And, Doctor, considering bradycardia or AV block risk in inferior MI, I’ve pre-applied defibrillator pads in case of emergency.”
My report wrapped up.
Silence on the line except for heavy breathing. Had I overstepped? Too cocky for a first-year?
At last, Park Woo-young caught his breath and spoke.
“…Hey.”
“Yes, Doctor.”
“For an EM first-year, that was a damn clean consult. Almost there. Hang tight.”
…Fuck.
I’d rattled it off without a single stutter.
Pride swelled for a split second—then that chilling comment hit me.
‘Are the medics done playing house? That’s cardiogenic shock territory. You prepping ECMO before rolling to the cath lab? What if they code on the table?’
Right. With the RV trashed and BP hanging by a thread, anything could happen during the procedure.
Heart stops cold, or uncontrollable shock. The last resort: a machine to take over for heart and lungs.
ECMO.
And that was cardiothoracic surgery territory.
I cut in urgently without thinking.
“Wait—Cardiology!”
“Yeah?”
The heavy breathing continued.
“Sorry, but we need to prep for cardiogenic shock and possible arrest. Okay if I call CT surgery now for VA-ECMO backup?”
Silence stretched on the line.
An EM first-year telling a cardiology fellow he’s calling CT surgery.
A total peon first-year.
Normally, the cardiologist doing the final procedure calls the shots.
But who knows. This guy didn’t sound all there either.
“Y-yeah… yeah, do it! If they question a first-year, drop my name!”
Okay.
Nailed it.