A Competent Doctor Can Cure Everything - Chapter 449



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A capable doctor

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Part 2 Episode 141

Traumatic brain hemorrhage

“Traumatic brain hemorrhage…?”

Kim Jin-su, who had been following my words with a blank expression, suddenly came to his senses.

Then he pointed to Sergei, who was watching our argument in bewilderment from behind.

“Then how do you explain that the patient’s pupillary reflex is normal?”

Sergei was now standing upright on his own two legs.

Sure, on the outside he looks fine.

But I wasn’t embarrassed.

“The patient said he was injured during a sparring match. In such cases, assessing brain damage based solely on pupillary reflexes is inaccurate.”

“Huh? Why is that…?”

“When athletes compete, adrenaline is secreted and the sympathetic nerves become excited. Then, what happens to the pupils?”

“… … !!”

Kim Jin-su’s eyes lit up with shock at my counter-question.

Sa Tae-ryong, who had been listening intently, clapped his hands instead of Kim Jin-su.

“Oh, that’s right! When the sympathetic nerves are excited, the pupils dilate, right? Then, even if there is brain damage, it might not be detected by the pupillary reflex…!”

Tae-ryong was right.

This was one possibility that occurred to me on my way here.

I opened my mouth and looked straight at Kim Jin-su.

“Once you gain experience as a team doctor or ring doctor (a dedicated doctor for a fighting sport), you realize that pupillary reflexes are difficult to use in diagnosing athletes in real-life situations.”

In theory, pupillary reflexes provide important clues to determining brain problems.

Normally, when light is shined into the eye, the pupil size should immediately decrease.

However, if there is cerebral edema, the pupil size decreases slowly.

If there is severe cerebral ischemia or death is imminent, the pupil size remains fixed and does not move.

Pin point pupils are very small, like dots, and can appear when there is pontine hemorrhage or drug intoxication.

‘But theory and actual clinical practice are different.’

In athletes whose sympathetic nerves are excited, the pupillary reflex is often meaningless.

Leaving Kim Jin-su behind, who was flustered, Sa Tae-ryong asked me.

“Senior! Then what do you mean when you say that the pulse is an important clue?”

Now the guy was looking at me with eyes as if he had won a thousand armies.

“Teacher Tae-ryong. You know that when intracranial pressure rises, blood pressure rises as a compensatory mechanism, and heart rate drops accordingly, right?”

When intracranial pressure rises, blood pressure rises to maintain cerebral blood flow.

This response increases cardiac output (the amount of blood the heart pumps out per minute), so the pulse rate (the number of times the heart beats per minute) slows.

Saetae-ryong followed my explanations well.

“Oh, okay! Then… that patient’s bradycardia could mean that his intracranial pressure is elevated?”

“That’s right. That’s why I mentioned the possibility of a brain hemorrhage.”

Cerebral pressure is normally maintained below 10 mmHg, but when it persists above 15 mmHg, it is said that ‘cerebral pressure is elevated.’

and….

In general, increased intracranial pressure often occurs secondarily due to cerebral hemorrhage or cerebral edema.

“… … !!”

Kim Jin-su’s jaw dropped wide as he realized the fact belatedly.

I thought this was the moment and complained a lot.

“In my opinion, our department’s senior, Shim Ji-seop, seems to have a more accurate judgment than EM Fellow Kim Jin-su. Oh, and at that time, our senior’s interpretation of patient Shim Ji-ah’s chest X-ray was also more accurate, right? How about getting some private lessons from our senior? He is quite capable.”

“This, this is…!”

Then, Jin-su Kim became angry, trembled, and didn’t know what to do.

An emergency room nurse approaches him and whispers.

“Dr. Kim Jin-su, what should we do? Should we send that foreign patient to the CT room as well?”

however.

Here, an unexpected event occurred that broke everyone’s expectations.

“… You’re talking nonsense. You’re making a big deal out of something that just happened to have a slight pulse. Absolutely not!!”

Is it because their pride was so hurt in front of their own family?

Kim Jin-su shouted with the veins in his neck rising.

At this point, I thought they would have prescribed a CT scan to quickly settle the situation and pretend like nothing happened.

The fellow seemed to have no intention of giving in.

Even.

“I remember your names and faces exactly. From now on, I will never accept any patients sent from the Oriental Medicine Rehabilitation Department. If an emergency patient comes up, you guys are the ones who are capable of handling it!”

He started threatening me, Ji-seop, and Tae-ryong while cursing at them.

Eventually, he starts to bully other emergency medicine residents around him.

“Hey!! You guys!! Why don’t you just prescribe an emergency CT scan for that foreign patient? You’d better be prepared not to see my face again.”

Even though they were busy with their own medical treatment, the doctors who had been glancing this way flinched greatly.

I was shocked at the circumstances that led to my return.

‘That guy, he came out like this?’

The emergency medicine department is already a very strict department compared to other departments.

At the fellow’s scolding, the emergency room interns and residents quickly turned their heads away, lost in thought.

I don’t think I can ask other doctors for help.

furthermore.

“Even after receiving emergency treatment for your ankle, never go to a Korean medicine clinic. Even if you get acupuncture for a hundred days, it won’t get better. Do you understand?”

Kim Jin-su walks between the emergency room beds.

Isn’t it like they’re shouting at the patients to make them listen?

“her.”

The three of us, including myself and the Korean Medicine Rehabilitation Team, looked at each other in genuine bewilderment.

That guy is a fellow? Has he aged backwards?

‘He’s not even an elementary school student, he’s so childish I can’t help but let him off.’

I felt embarrassed to see the patients and Tae-ryong, and my face started to burn.

* * *

Sergei and our trio of Korean medicine rehabilitation specialists were helplessly pushed into a corner of the emergency room.

“What’s going on?”

The patient just seems bewildered by the whole situation.

“Ugh… Seniors, what do we do now?”

Saetae-ryong is on the verge of panic.

Meanwhile, Shim Ji-seop… had a face that I was seeing for the first time.

‘Are you impressed? Are you surprised?’

I glanced at my senior with a bashful expression, and then he finally started talking.

“I didn’t know that Mr. Seonjun Seon would be like this.”

“What?”

“Well, what should I say? You seem to think of me more favorably than I thought.”

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… What did I say just now?

I think I was so angry that I ended up saying some embarrassing things.

I cleared my throat and changed the subject.

“Okay. By the way. We need to examine patient Sergei quickly.”

Elevated intracranial pressure is a life-threatening condition that requires prompt treatment.

But now that EM Fellow is so upset, it’s time to take the inspection order.

Damn it… What good are CT scans and X-rays if you know how to read them? Oriental medicine doctors don’t have the authority to prescribe them.

Times like this really make me sad.

In the meantime, Shim Ji-seop and Sa Tae-ryong exchange opinions.

“Let’s quickly find a nearby hospital. If the patient really has a cerebral hemorrhage, it would be a big problem.”

“Yes! If we split up the calls, I think we’ll find a friendly emergency room.”

But I pursed my lips.

Ah… this is a bit off.

It is uncertain whether other hospitals will accept it.

If it’s a real cerebral hemorrhage, every second counts.

Rustle.

I took the emergency contact list paper out of my coat pocket.

There is a list of our hospital doctors who are on duty.

The contact information for emergency rooms at other nearby hospitals was written down.

‘…uh?’

That was when.

As I was examining it anxiously, something caught my eye.

“Just a minute, I’ll just make a phone call.”

“?”

Leaving the group behind, I hurried out into the hallway outside the emergency room and called someone.

Soon a dry voice answers.

– Yes, this is Lee Dal-nim from the Department of Internal Medicine.

“Dalnim-ah. It’s me.”

– Oh? Teacher Seon-i-jun? Weren’t you off during the Lunar New Year holidays?

“I was like that, but I’m here because a patient I’m in charge of has an emergency. I need your help… Can I ask you a favor?”

– What is it?

I quickly summarized the circumstances.

After a moment of silence, Idalnim asks again.

– So you want me to prescribe an emergency CT scan?

I held the phone tightly to my ear.

The person giving the order does not necessarily have to be an emergency medicine physician.

However, the emergency room does not like having their territory invaded.

It’s just not usually done because it can cause blemishes.

– … … .

The phone was quiet, so I wet my dry lips.

Of course, it must be burdensome to be in the emergency room, especially with that damn Kim Jin-soo.

I was about to apologize and end the call.

– Okay. I’ll give you the order right away.

“…! Really? Are you okay?”

– I also received help from Teacher Lee Jun last time with the Cheon Yu-ra case. And what about the EM Fellow? What do you want me to do? It’s not that scary, is it?

Idalnim’s characteristically laughter was heard over the radio waves.

I breathed a sigh of relief.

As expected, it was a reaction typical of Lee Dal-nim, who is not attached to worldly things.

Now, when the order comes down, I will call Sergei from the CT room.

“Thank you so much, Lee Dal-nim.”

I thanked her again and again.

I was able to return to my group with a much lighter heart.

* * *

Thud, thud, thud.

Inside the Korean Medicine Rehabilitation Center and the National Institute of Oriental Medicine, the sound of Sim Ji-seop and I loitering around echoes.

To check Sergei’s CT results, I need a computer with access to his EMR (electronic recording).

‘I can’t borrow the emergency room computer after having a huge fight with Kim Jin-su just now, right?’

So, we decided to check the test results on the computer in the oriental medicine ward.

However, Sergey decided to stay with the patient until Sergei finished his examination.

Even if he’s Kim Jin-su, he wouldn’t kick out patients and interns from the CT scan room.

I was having such a heartbreaking time.

“The results are out.”

After anxiously pressing refresh repeatedly, the CT scan results finally came out.

“Professor Seonjun Seon. Do you know how to read Brain-CT?”

“Yes, in general.”

“As expected. They’re different from the usual first-year students.”

Shim Ji-seop’s admiring gaze lingered on me for a moment.

I will have to ask the radiology department for a formal interpretation later.

I can read to some extent on my own.

‘Of course, it felt very difficult when I was an intern.’

I’ve been watching as many videos as I can whenever I have time.

Also, I had the benefit of learning from each department’s professors while interning.

Our senior Shim Ji-seop, who is good at everything, obviously knows how to read CT scans.

“hmm….”

There was a brief silence as everyone stared intently at the monitor.

And after a while.

We both jumped up from our seats without saying a word.

“This is…! Just as Mr. Seon Ijun thought, it was an emergency, a super emergency at that.”

“I didn’t know it would be this bad, it’s more serious than I expected.”

CT clearly showed a dark area suggesting cerebral hemorrhage.

At this time, it is important to consider the movement of the brain’s center line (midline shifting).

This patient’s brain center line was displaced by a whopping 3 mm.

For reference, if this is pushed out by 5mm, the patient will fall into a coma.

“This is the first time in my entire life of training that I have encountered a case like this. I don’t know how I was so conscious in this state.”

Even the always easygoing Shim Ji-seop stuck out his tongue.

“Senior, let’s go quickly. If we’re any later, this patient will be in big trouble.”

I took the lead and opened the door to the hospital with all my might.

Now was not the time to marvel at the mysteries of the human body and the brain.

We rushed to the emergency room.

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