Chapter 30
Chapter 30
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Translator: crow
Chapter Title: Securing the Airway is Important (3)
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I sat on the sofa in my officetel, repeatedly slashing and suturing an imaginary throat in midair dozens of times.
This lesson was starting to get interesting.
Anonymous (211.36): Alright! Get your head in the game! Next problem!
A new anatomy image was uploaded.
The epiglottis. The small flap that opens and closes the airway.
What should have been thin and pink was swollen bright red.
The puffed-up epiglottis looked ready to burst, nearly blocking the already narrow airway.
Anonymous (211.36): Alright! Patient with acute epiglottitis—the throat's swollen shut! Barely breathing now, but the airway could close completely any second. Need to intubate right away. What tube size do you use, and what's the procedure?
Ugh.
This was a trap.
Shoving a laryngoscope in recklessly could irritate that sensitive swelling and cause total airway closure.
Sweat beading on my forehead, I desperately scribbled the answer in my mind.
Hell Joseon Slave 1: Use a smaller tube than usual. Maybe one or two sizes down.
Anonymous (211.36): Why?
Hell Joseon Slave 1: The whole airway's swollen. Standard size probably won't fit.
Anonymous (211.36): Correct. Anything else to watch out for? What do you prepare, what do you avoid? Explain in detail.
I racked my brain. Minimize stimulation first.
Hell Joseon Slave 1: Don't recklessly press the tongue or probe with the laryngoscope. Keep the patient as calm as possible. Especially in kids—top priority is sedating them so they don't cry or thrash.
Right then, the Pediatrics Ghost popped up like a demon.
Pediatrics Ghost 77: Hey! Finally sounding like a doctor! Never shove a tongue depressor in a kid's mouth! They get scared, start crying, and boom—airway blocked, turning blue instantly! Hold them with mom, keep 'em comfy, gentle oxygen only!
Anesthesiology Pain Medicine: And this isn't a corner-room ER procedure. Principle is: most experienced doc, with ENT and anesthesiology on standby. If intubation fails, ENT slits the throat for tracheotomy right there.
God's Scalpel: Touch that with your amateur hands, 100% airway closure. You just watch from the side. If it goes south, slice the throat like I taught you.
I engraved their lessons in my mind.
As soon as the lecture ended, the next image uploaded.
Anonymous (211.36): Okay, next: patient gushing blood from the throat!
Before my eyes appeared the throat of a tonsillectomy patient.
A vessel in the surgical site had burst—bright red blood was spurting from deep inside like a fountain.
Anonymous (211.36): Probably secondary bleeding post-tonsillectomy! How do you handle it? Blood's about to block the airway. What's priority? Patient can't breathe, sats dropping fast.
Uh, wait, what was it?
Suction the blood first, right?
Hell Joseon Slave 1: Suction?
Anonymous (211.36): Suction's basic, dumbass!
Anesthesiology Pain Medicine: Suction's basic, then secure the airway. Use the largest laryngoscope blade to sweep tongue and clot at once, shove the tube in fast, secure airway, inflate the cuff so blood doesn't go into the lungs!
Airway securing, and airway protection.
Got it.
Note note.
And so, on my officetel sofa, I killed and revived imaginary patients dozens of times.
***
The alarm rang.
Same time, same sound.
Signal to return to hell.
Dragging my study-wrecked body, I mechanically prepped for work.
What can you do.
Morning in the ER flew by faster than expected.
Not too busy, mostly minor cases—no big burden.
Afternoon in the ER was the usual madhouse.
I hunkered in the station corner, charting a simple laceration patient who'd just rolled in. Drunk guy stumbled and smashed his head on asphalt.
"Ugh, mister. Ease up on the booze."
Muttering to myself, I kept charting.
The ER's dull, draining routine.
After ten of these a day, my soul feels like gauze soaked in antiseptic—frayed to hell.
That's when it happened.
"Dr. Han!"
The veteran triage nurse's voice boomed from the desk.
"Come here a sec? New patient—needs a quick look."
One line from a vet nurse always chills my spine.
Shiver.
I saved the chart and stood.
At the triage desk sat a young guy, early 20s, face pale with fear.
I pulled up a chair beside the patient.
"Yes, sir. What brings you in?"
He glanced at me anxiously and answered.
"Uh... had tonsillectomy last week. Smells bloody, feels like something's there..."
Aha, hold on—tonsil surgery?
Bloody smell?
"You had tonsil surgery a week ago here? Throat smells fishy, foreign body sensation? Tell me more."
"Doesn't hurt much... but fishy smell from throat keeps coming, and swallowing feels like something surges up. Super gross..."
I reassured him and grabbed a penlight.
"Okay, open wide? Let me check your throat."
He opened.
I shone the light deep, at the tonsil bed.
Seemed fine at first.
But pressing the tongue lightly with a depressor to get a view...
There it was.
A tiny gap in the surgical scab, bright red blood droplet oozing out.
Slow, but definitely active bleeding.
My mind went blank.
Just trickling now, but one blood pressure spike or bad cough, and that vessel blows—ticking bomb.
'Fuck.'
Masking panic, I asked the patient.
Hoping my voice wouldn't shake.
"Did you have the surgery here?"
"Yes. Week ago, with Professor Kim Jae-young in ENT..."
His answer hit, and ghosts from hell training flashed in my mind.
'Alright! Patient gushing blood from the throat!'
'This is airway first. Airway priority, idiot!'
'Largest laryngoscope blade to sweep tongue and clot, shove tube in fast, secure airway, inflate cuff—no blood to lungs!'
...Crazy. That's why the ghosts drilled airway? Shamans or what?
Ah, right—ghosts. Ghost senses or whatever.
"Sir, listen carefully from now on. There's some bleeding at the surgical site. Not automatically dire, but prepping for any just-in-case worst-case."
I turned from the patient and yelled to the nurse behind me.
"Get an A-zone bed for this patient, stat! Start monitoring now! Post-op bleeding!"
My urgent shout froze the peaceful ER air.
"And secure two IV lines bilaterally now! CBC and coag panel STAT, PRBC 4 units crossmatch prep!"
My mouth wouldn't stop.
"Call ENT on-call now! Post-tonsillectomy active bleeding! They need to come down!"
I caught my breath and gave the last order.
"And... largest size laryngoscope blade, 7.5 tube, suction ready bedside. Right now."
Nurses sprang into action.
One grabbed IV access, another labeled blood tubes.
At least not massive bleeding yet.
For now.
But this type can explode anytime.
Until ENT and anesthesiology arrive, one job:
Keep things stable.
"Nurse, Bossmin ampules, long Kelly forceps, packing gauze please."
I requested supplies.
Moments later, stainless tray arrived.
Soaked gauze carefully in Bossmin solution. Clamped it firm on the long forceps end.
"Sir, gonna press the bleed site to stop it. Might be uncomfortable. Open wide."
Explaining, I eased the forceps deep into his throat.
Found it.
Tonsil bed located.
Pressed the bleed site hard with the long forceps.
He grimaced. I soothed him, keeping steady pressure on the forceps.
Then, a flat voice from behind.
"What's this?"
Didn't need to look. Han Jae-eon, third-year EM.
She'd sidled up, hands in pockets, peering down.
Gripping forceps, I turned my head slightly for briefing.
"22-year-old male, tonsillectomy here in our ENT a week ago. Post-op bleeding noted, packing with Bossmin gauze now. Active but mild, just oozing. Vitals stable, notified ENT and anesthesiology."
Han Jae-eon nodded, leaned to glance in the throat.
"Hmm. Oozing. Not arterial blowout. Keep pressure till ENT gets here."
With that, she headed back to the station.
What, no help?
Before the thought finished, she grabbed something and returned.
Ah, not ditching.
I refocused on the patient.
Felt the pulse through the forceps.
No more blood seeping from the site.
Pressure hemostasis working.
Phew, good thing it's not heavy bleeding.
This'll cauterize and done.
Relief sighed out.
Luckily, no need for those ghost-taught hellish airway skills today.
Reality's not that dramatic.
Not every patient crashes to worst-case.
I eyed the monitor's steady vitals, waiting for this boring pressure time to end.