Chapter 96
Chapter 96
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Translator: crow
Chapter Title: Dropping the Bomb (3)
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“Precisely, we approached it not as fundamental treatment but from the concept of damage control.”
I gripped the microphone tighter in my hand.
“The answer to the role during that gap period you asked about, Professor, I’ll explain in detail once more in the conclusion part of my presentation.”
Without giving them a chance to counter, I turned back toward the audience.
*Phew. Didn’t shake.*
“Now, let’s continue the presentation.”
I took a step away from the stiff podium.
*Yesterday’s YouTube TED binge was worth it. Walk like Steve Jobs. Naturally.*
I began gesturing lightly with my hand.
“This is the case we faced.”
*Click.*
The slide changed.
[Slide 3: Case - Patient Arrival]
“The patient was a 54-year-old male…”
I recalled that horrific memory from the night before, when I’d reviewed the data until the very end.
“He arrived on foot, accompanied by a coworker—his guardian—who was dressed in construction work clothes.”
I emphasized the word “on foot.”
“As you can see, there was no prior contact through emergency services of any kind. He was literally a patient who suddenly pushed open the emergency room doors and walked in.”
“The patient’s chief complaint was…”
*Click.*
A gruesome photo appeared on the screen.
A rusted rebar, caked in dirt and cement as if taken at a construction site.
A low gasp rose from the audience.
“Penetrating abdominal injury from the rusted rebar.”
*Click.*
The rebar photo slid to the corner, replaced by the records from arrival.
[Initial Vital Signs: BP 60/palpable, HR 130/min, RR 30/min]
“Initial vital signs measured immediately upon arrival showed blood pressure of 60, heart rate of 130, respiratory rate of 30. By ATLS classification, it was a clear Class IV shock state.”
I paused for a moment and looked out at the hundreds of doctors in the audience.
“Yes, as all you doctors here know well, the survival odds for such a patient are extremely low.”
*Click.*
Next slide.
[Slide 4: Case]
“We immediately moved the patient to the resuscitation bay and performed a FAST ultrasound per protocol.”
*Click.*
“And that’s how we confirmed massive hemoperitoneum.”
*Click.*
The next text appeared.
[MTP (*Massive Transfusion Protocol) activated, O-negative blood transfusion initiated]
[No blood pressure response despite continuous fluids and transfusion]
“We activated MTP right away and started transfusing O-negative packed red blood cells without cross-matching. But even squeezing fluids and blood through pressure bags, the patient’s blood pressure showed no response, hovering around 50 mmHg.”
I caught my breath.
Now came the climax of the buildup.
“So, what’s the first name that comes to mind in the ER? None other than…”
*Click.*
Four massive letters slammed into the center of the screen.
[Trauma Surgery]
“That’s right. Trauma Surgery, the department responsible for managing severe trauma patients. Naturally, we called the Trauma Surgery team immediately.”
I took another step toward the edge of the stage.
“But that day, our hospital’s top team dedicated to trauma couldn’t care for this patient right away.”
*Flash.*
A bold red text box covered the screen.
[Trauma Surgery team confirmed delayed arrival by at least 15 minutes due to another emergency surgery]
The lecture hall began buzzing again.
To this patient, 15 minutes was no different from a death sentence.
“At least 15 minutes. Time the patient couldn’t afford.”
I looked back at the Asung Hospital doctor who’d been glaring at me.
“So, what could we consider then?”
*Click.*
Slide 5’s turn.
[Slide 5: Emergency Department-Led Emergency Resuscitative Laparotomy]
The entire hall’s murmurs fell into perfect silence once more.
“That’s right. Emergency resuscitative laparotomy.”
As the presentation reached its peak, my body began to tremble.
*Calm down.*
*You’ve simulated this a hundred times.*
“Our Emergency Medicine team decided on immediate laparotomy in the resuscitation bay, led by Emergency Medicine, as the only and final measure to prevent imminent death.”
*Click.*
[Midline incision performed]
[Massive intraperitoneal hemorrhage of approx. 4L+ and splenic rupture (Grade 4) confirmed]
“We performed a midline incision from the xiphoid process to the pubic symphysis. Immediately upon opening, visually confirmed intraperitoneal hemorrhage was over 4 liters.”
*Click.*
The next slide appeared.
“We secured initial visibility by suctioning out the intraperitoneal blood…”
The conference hall buzzed again.
“And here’s how we identified the splenic rupture.”
A new title and diagram appeared on the screen.
[Four-Quadrant Packing]
“What you see on screen is a simple anatomical diagram dividing the abdomen into four quadrants. Massive hemorrhage made immediate visualization impossible upon opening. We immediately applied the basic principle of damage control surgery—four-quadrant packing—packing the entire abdomen with gauze to compress and induce temporary hemostasis.”
I pointed the laser pointer at the right side of the diagram.
“Right upper quadrant, where the liver is, and right lower quadrant—both clear. No additional bleeding observed even after removing the pads.”
I moved the pointer to the upper left.
The audience’s eyes followed the red dot in unison.
“But the moment we removed the pad from the left upper quadrant, where the spleen is…”
That day’s memory flashed vividly.
The horrific moment when blood surged again.
“We confirmed uncontrolled arterial bleeding gushing out.”
I stared straight at the face of the Asung Hospital doctor who’d been shooting daggers at me.
“We immediately diagnosed splenic rupture and repacked the area, fully controlling the hemorrhage, and finally could wait for the surgical team.”
*Flash.*
[Slide 6: Case - Surgical Treatment and Outcome]
[Door to OR?]
“After primary damage control packing in the ER, the patient was transferred to the emergency OR in our Emergency Medical Center building with temporarily stabilized vitals. The waiting Trauma Surgery team immediately performed splenectomy, and…”
Now it was time to reveal why I was standing here.
[Slide 7: Patient Prognosis]
[Discharged without neurological complications after ICU and ward care]
A photo of a man filled the screen.
A middle-aged man in neat casual clothes.
“This photo is the patient as we saw him seven months post-accident in Trauma Surgery outpatient clinic. It’s mosaicked with the patient’s consent.”
I could feel the tension filling the lecture hall melt away like snow at the sight of this one photo.
The murmurs started up again, but this time it was admiration and relief, not shock.
“As you can see, he’s in remarkably good health.”
I smiled, recalling the gruff conversation between Professor Kang and the patient that day.
“Even cracking jokes.”
*Click.*
The touching photo vanished.
I readjusted my grip on the presenter.
The warm atmosphere ended here.
A new slide appeared.
[Slide 8]
[Role of Emergency Physicians: How Far Does It Go?]
I felt the air in the lecture hall cool again.
“Surgical intervention delays…”
I slowly swept my gaze over the audience and began reciting the perfectly memorized logic.
“…happen not infrequently in domestic and international medical realities. It’s an even more serious issue in secondary hospitals like ours that aren’t regional emergency centers, or local hospitals without 24/7 surgical specialists.”
I nodded.
“The patient we faced couldn’t wait 15 minutes for a surgeon.”
I paused and posed a question to the audience.
“So, should Emergency Medicine physicians remain in that passive role of just stabilizing and handing off the patient?”
I locked eyes precisely with the Asung Hospital doctor who’d thrown the provocative question at me earlier.
The screen flashed.
[Can’t we fill this treatment gap for the patient’s survival?]
The lecture hall was so silent you could hear a pin drop.
I immediately brought up the next slide.
[Slide 9]
Half the screen filled with the cover of an unfamiliar paper.
[Paper screenshot: Case Report…]
I pointed the laser at the English title of the paper.
“A case report. 19-year-old female, blunt cardiac rupture.”
The professors in the front row furrowed their brows.
“The Niigata University Sado Hospital handling this patient at the time faced a situation where immediate surgical intervention was impossible.”
“So.”
I emphasized the next sentence.
“The emergency physician performed emergency resuscitative thoracotomy and direct left ventricular rupture repair right there in the ER resuscitation bay.”
“Whoa…”
“Crazy…”
Murmurs washed over like a wave.
Stitching a heart in the ER.
An EM doc, no less.
I noted the stir and brought up the next slide.
*Flash.*
[Outcome: Patient survival with good neurological prognosis]
“The patient survived. Not just barely clinging to life, but with a good neurological prognosis.”
I highlighted the paper’s conclusion.
[Conclusion: …Ongoing education systems and guideline consensus are needed for regional emergency physicians to perform surgical procedures.]
“A paper published just four years ago in the Japanese Journal of Emergency Medicine.”
I addressed the audience.
“This paper from our neighbor boldly asks, ‘Should emergency physicians become temporary surgeons?’ and concludes, ‘Yes. If necessary, we must create the education system.’”
I pressed the button on the presenter.
Final slide.
[Slide 10: Conclusion and Proposal]
“Here’s the conclusion.”
I took a deep breath.
“I propose that more proactive education on REBOA and selective damage control techniques like what we performed be incorporated into Emergency Medicine training, along with interdisciplinary discussions.”
The screen went black.
The presentation was over.
I slotted the mic back into the stand and bowed 90 degrees to the audience.
“That’s all. Thank you.”
…
Silence.
The hall fell quiet.
No applause, no murmurs.
The hundreds of doctors who’d heard such an audacious presentation just stared blankly at the black PPT screen.