Chapter 171: Critical Moments in the ICU

Director Liu would go from bed to bed, actively explaining each patient’s symptoms and the targeted treatments they were receiving. Whether it was medication, respiratory support, hemofiltration, physical cooling, or decompression techniques, every measure was aimed at saving lives.

Compared to Dr. Hu, Director Liu taught him a range of treatment theories that were both deep and accessible, along with their practical applications.

Dr. Hu, on the other hand, taught him how to operate various instruments and adjust their parameters.

He also learned basic critical care knowledge and standard procedures, such as medication pumps, monitoring urine output, body temperature, and breathing.

In short, Director Liu’s lessons in emergency rescue were on an advanced level.

“Patient in Bed 11 is a 17-year-old girl—very young. Her symptoms include recurring low-grade fevers, breathing difficulties, and a lung infection with coughing and copious sputum. The attending doctor’s investigation suggested it might have started as a mild flu.”

Zhou Can looked at the nearly lifeless girl on the bed, completely overwhelmed by drowsiness.

A persistent low fever could sap one’s strength, leaving the body tired and in a constant state of sleepiness.

A mild flu that landed her in the ICU—it was hard to tell if it was misfortune or destiny.

Though it seemed like an innocuous flu, this disease claimed many lives every year.

Even in such a dire state, the girl’s haggard beauty still shone through.

She was tall with exceptionally fair skin and a natural rosy glow.

Her hair wasn’t jet black; it had a tinge of yellow.

It was hard to tell if it had been dyed.

Her prominent nose left a strong impression.

There was a striking, mixed-race beauty about her.

Zhou Can then focused on the ventilator’s settings.

The tidal volume was set to 9 ml/kg and the respiratory rate was 16 breaths per minute.

The inspiratory flow rate was set at 80 ml per minute.

This inspiratory flow rate was clearly a bit too high.

Dr. Hu explained, “When a patient has a fever, is agitated, or is convulsing, you need to increase the flow rate. But when they are calmly sleeping, it should be reduced.”

“Could it be COPD?”

Zhou Can asked curiously.

“Exactly! This is the kind of illness—and it’s likely congenital,” replied Director Liu with a slight nod.

“A congenital obstructive pulmonary disease?”

Zhou Can frowned as he picked up the patient’s test report: chronic airway inflammation and a deficiency of antielastase in the blood.

No wonder Director Liu labeled it a congenital condition.

Chronic obstructive pulmonary disease, or COPD, is a persistent inflammatory disease of the airways.

The ongoing airway inflammation leads to various pathophysiological changes in patients.

The most common change is the restriction of airflow.

Subsequently, patients experience symptoms like coughing, sputum production, and breathing difficulties.

There are numerous causes of COPD; a deficiency of antielastase in the blood is one very rare congenital type.

It is said that this condition is related to ethnicity.

It rarely affects Asians; in Caucasians, genetic mutations can mean that babies are born without sufficient antielastase.

No wonder the girl looked like she might be of mixed heritage.

One of her parents was likely Caucasian.

Antielastase is primarily found in alpha-1 globulin.

It works by inhibiting a variety of enzymes, such as trypsin, elastase, fibrinolysin, thrombin, collagenase, leukocyte protease, and elastase.

A deficiency in this enzyme can lead to the development of emphysema.

Currently, there is no cure for this disease.

“You’re an expert in respiratory medicine. Is it really impossible to cure a deficiency in antielastase?”

Director Liu shook his head helplessly and replied, “For now, there are far too many diseases that we can’t cure. Doctors often feel powerless in the face of some illnesses.”

At the moment, all we can do for this patient is to do our best to help her overcome the critical phase.

After reviewing the patient’s temperature, suction frequency, and urine output records, Director Liu instructed the attending doctor, “Her sputum is clearly abundant and her lungs are heavy with moisture. Make sure not to set the tidal volume too high.”

“Understood!”

The attending doctor, a senior resident in his early thirties with a tall, quiet demeanor, was known for his serious work ethic as shown in his meticulously kept bedside records.

Director Liu then led Zhou Can to check on the other patients.

………

The eight-hour shift flew by in no time.

Zhou Can accompanied Director Liu as they checked on their group’s patients; when emergencies struck in other groups, Director Liu would lead him to assist. Occasionally, other doctors would urgently seek his help.

After the handover, in the doctors’ duty room, Director Liu reviewed the orders and found nothing amiss.

He looked over his shoulder at Zhou Can.

“Xiao Zhou, after spending the entire day shadowing me, what have you learned?”

“I’ve gained a lot—I learned various medications and rescue methods for critical patients, as well as a deeper understanding of how to operate the equipment.”

Zhou Can had indeed absorbed a wealth of life-saving knowledge and techniques for treating critically ill patients.

“That summary is a bit vague. Can you condense today’s lessons into some key points?”

Director Liu was deliberately testing him to see if he was paying attention.

After a moment’s thought, Zhou Can summarized, “When both heart and breathing falter, restore the heartbeat first, since the oxygen in the blood can support life for a while…”

“Don’t get too specific—just summarize what you’ve learned today,” Director Liu quickly interrupted before he could finish, seemingly determined to trip him up.

“Well…in treating patients, we must first ensure that both the internal and external circulations are maintained. Among these, breathing and heartbeat are the most crucial. Once those are secure, address body temperature, blood pressure, and low oxygen levels. And if the nervous system fails and both heart and breathing stop, immediately establish extracorporeal dual circulation.”

Zhou Can provided a comprehensive summary.

In most cases, only brain death causes nervous system failure that results in the abrupt cessation of breathing and heartbeat.

At that point, saving the patient’s life doesn’t hold much meaning.

However, there are many cases where patients in a vegetative state have been successfully revived.

It’s all about hoping for a miracle.

“That’s much better. It seems like your hard work today wasn’t in vain,” Director Liu said with a nod of satisfaction.

Director Liu was pleased with Zhou Can’s learning ability, insight, and work attitude.

He had spent a great deal of time personally mentoring Zhou Can, and if Zhou Can ever slacked off or pretended to be diligent without truly learning, Director Liu would cut him off.

“Remember, as doctors in the Critical Care Department, our approach to saving patients differs fundamentally from that of specialists. While specialists first focus on curing the disease, we prioritize saving lives. Go home and reflect on today’s lessons, and be ready for the evening shift tomorrow.”

After speaking, Director Liu left in a hurry.

As Zhou Can was about to leave, Dr. Shi called him back.

“Dr. Zhou, I’m planning to write a paper on the patient in Bed 7. I’ll include your name as well. If you’re interested, join me in this research,” Dr. Shi said, as direct as ever.

“Thank you! I’m more than willing to help as long as you don’t mind having me as extra assistance.”

Zhou Can readily accepted the opportunity—Dr. Shi was being more than generous.

Even if Dr. Shi chose not to include his name in the paper, it was still a great chance.

“Dr. Shi, Dr. Shi, the patient in Bed 6 has regained consciousness!” a nurse excitedly ran over to inform him.

“Conscious? I’ll go check immediately,” Dr. Shi replied briskly.

Dr. Shi quickly headed toward the Critical Care Unit, with Zhou Can following close behind.

The patient in Bed 6 had woken up after the operation he performed on her.

Inside, they confirmed that the patient had opened her eyes and appeared alert—her gaze was clear, not vacant.

“That’s fantastic! This shows that there’s still much room for improvement in our treatments in the Critical Care Department,” Dr. Shi remarked with deep emotion.

Just yesterday, the patient had required emergency rescue multiple times.

Yet after the operation, within merely a day and a night, she had awakened from a critical, comatose state. Her vital signs stabilized quickly, and she improved in all aspects.

Sometimes, saving patients was like fighting a war.

Once you locate the disease’s ‘command center’ and defeat it, the enemy collapses like a fallen army, and the patient’s condition rapidly improves.

It wasn’t a dream for patients to be transferred out of the ICU in just two or three days.

“Dr. Zhou’s warrior spirit might just inspire the Critical Care Department to upgrade its treatment methods. In the past, we were too conservative. Perhaps taking the initiative is the right approach,” Dr. Shi said.

Treatment in the Critical Care Department had indeed been overly conservative. Many medical staff only focused on keeping patients alive, leaving everything else behind.

More aggressive and bold treatments meant higher risks, and few doctors were willing to take that gamble.

“Dr. Shi, the patient in Bed 22 requires a central venous pressure line, but her veins are rather difficult to puncture. Could you lend a hand?” a nurse called over urgently.

“Alright!”

Dr. Shi, originally trained as an anesthesiologist, was thoroughly familiar with various life-monitoring procedures.

Monitoring central venous pressure is an invasive procedure.

A central venous catheter must be inserted through the internal jugular or subclavian vein, with its tip positioned at the junction of the right atrium and the superior and inferior vena cava, for measurement. This procedure is not an easy one.

Especially with patients whose veins are thin and hard to locate, the procedure becomes exceptionally challenging.

The resident attempting to set up the central venous pressure monitoring was already drenched in sweat.

“Let me give it a try!”

Dr. Shi stepped forward to take over.

However, his brows quickly furrowed and his expression turned extremely focused.

Beside him, the equipment emitted an aggravating alarm that wouldn’t stop ringing.

The patient’s blood oxygen saturation was alarmingly low.

It was clear why the resident was desperate to set up the central venous pressure monitoring.

“Damn, this patient’s veins are both thin and slippery,” Dr. Shi muttered after two failed attempts, his frustration evident.

Zhou Can, who had followed along to learn, stood by watching intently.

Doctors rarely spent time practicing injection techniques—it was just a shot, something anyone could do.

Especially when many medications can simply be injected intramuscularly, it was usually a routine procedure.

“I’ve practiced my injection technique. May I give it a try?” Zhou Can asked anxiously.

The operation, which seemed trivial to him, was proving extremely difficult for both the resident and even for Dr. Shi.

The small size of the patient’s veins was indeed a factor, but ultimately it boiled down to the doctor’s skill.

“Be careful. Don’t hit an artery or nerve,” Dr. Shi cautioned, somewhat apprehensive yet trusting Zhou Can enough to let him try.

Zhou Can took the needle and, with a casual motion, punctured the vein.

Both Dr. Shi and the resident felt their hearts race as they watched.

Was that really how one could insert so effortlessly?

It was surprisingly precise.

After all, this was the neck!

But as soon as they saw dark red blood flowing through the connected catheter, both men’s faces lit up with relief.

The attractive nurse nearby looked at Zhou Can with admiration.

She thought the new Dr. Zhou was extremely impressive—his injection skills even outshined those of the Head Nurse.

Zhou Can was currently at Level Four in injection technique—standard attending level, nearly reaching excellence. Not even many head nurses could compare to him.

“Alright!”

Zhou Can casually stepped aside.

“Thank you, thank you!” The resident repeatedly expressed his gratitude.

Once central venous pressure monitoring was established, it allowed for measurement of the mixed venous oxygen saturation, known as Sov2.

This parameter helped doctors accurately gauge the heart’s output.

With ScVo2 approaching 40, it was no wonder the alarm kept ringing.

When blood oxygen saturation fell to such levels, mortality rates soared.

“The heart’s output is too low! Administer inotropes immediately!” Dr. Shi directed from the side.

After using inotropes, the patient’s blood oxygen saturation improved significantly and began to climb.

Everyone heaved a collective sigh of relief.

Crisis averted.

“I never expected Dr. Zhou’s injection skills to be this strong! From now on, whenever we face patients with thin and slippery veins requiring catheterization, we’ll call you in,” Dr. Shi remarked.

It wasn’t often that the usually laconic Dr. Shi would speak so freely, clearly astonished by Zhou Can’s skill.

Even now, he still found it hard to believe and felt a twinge of awe.

With one effortless puncture, Zhou Can had accurately accessed the vein—a display of mastery and poise.

“Alright then, no problem! As long as the other doctors don’t worry about me causing any mishaps,” Zhou Can joked, earning laughter from those around him.

Soon enough, his shift was over and he left promptly.

However, his feats and achievements were already quietly spreading through the Critical Care Department.

Within just three days of joining, he had revived two critical patients, along with several other eye-catching operations.

Talented individuals always managed to earn the admiration and respect of their colleagues.

In the days that followed, as patients from Beds 6 and 7 were transferred out of the ICU, Zhou Can’s reputation grew even more.

During his duty shifts, more and more people sought his help.

At first, other doctors hesitated a bit out of pride—it was somewhat embarrassing to ask a trainee for help.

But soon, after Zhou Can had helped three high-risk patients recover rapidly and be transferred out of the ICU, nothing could stop them.

Now, regardless of pride or face, aside from terminal cases like cancer, every doctor wanted Zhou Can’s opinion.

Zhou Can was more than happy to help—it was an opportunity to build relationships and gain diagnostic experience.

Sometimes, if luck was on his side, he even earned extra points in medical expertise.

Especially when his experience in pharmacological differentiation grew, it made him very happy.

As he grew more familiar with the Critical Care Department colleagues, Zhou Can frequently volunteered for tasks like urinary catheterization, endotracheal intubation, and punctures.

His experience in device implantation in the Critical Care Department finally skyrocketed.

Some even jokingly called him the ‘Catheter King,’ but he didn’t mind at all.

After all, each catheter inserted earned him one point in device implantation experience.

His current level in implantation was Level Four, and to reach Level Five, he needed one thousand points.

He knew he had to work diligently to achieve his goal soon.

As his skills in the Critical Care Department grew, so did the responsibilities on his shoulders.

At first, only Director Liu pushed him harder.

Later, deputy attending physicians and attending physicians from other groups also began to take notice—as long as Zhou Can wasn’t too busy, they’d call on him for help.