Chapter 28
Tension pneumothorax refers to the rupture of a larger pulmonary air sac or a significant and deep lung laceration or bronchial rupture. The fissure communicates with the pleural cavity, forming a one-way valve, also known as high-pressure pneumothorax.
After tension pneumothorax forms, during inhalation, the pressure in the pleural cavity decreases, the valve opens, and gas enters the pleural cavity; during exhalation, the pressure in the pleural cavity increases, the valve closes, and gas cannot escape from the pleural cavity.
The more one breathes, the higher the pressure inside the pleural cavity, firmly compressing the lungs. Eventually, the lungs collapse entirely, unable to expand...
No matter how hard the patient struggles to breathe, they can't get a breath in.
This is one of the most life-threatening emergencies. Except for slashing the carotid artery or if the aorta in the chest or abdomen ruptures, other internal bleedings are fatal but not as rapid.
Death by suffocation occurs in an instant.
"Priest?"
The Temple of the War God is indeed adjacent to the military camp. Dashing there and back would take at most five minutes. But the patient lying on the ground couldn't wait for five minutes!
"50ml syringe!"
No response.
No one handed him anything. No syringe, no needle, no drainage tube...
No one knew what he needed, why he was doing this, or even what the patient's condition implied.
This is a different realm, not their hospital, not the emergency department he'd worked in for over a decade.
Garrett looked around. Anxious faces surrounded him, staring at the patient, gazing toward the temple nearby, hoping for the priest to come rushing in. Some even gestured to remove door panels, grab shields, wanting to lift the patient toward the temple...
By the time you lift the person, they'll be dead!
Garrett panicked. He forcefully stood in front of the patient, one arm outstretched, the other grabbing Sir Flynn:
"I'm a healer! I can save him! Captain, help me!"
"You can save him?"
Sir Flynn immediately halted his steps. Garrett nodded vigorously:
"He's dying! I can save him! I'm missing something, Captain, help me!"
Sir Flynn hesitated.
Garrett had learned healing techniques, something he'd just heard from Captain Karen; no matter how much he trusted Karen, hearsay wasn't the same as witnessing it firsthand.
Moreover, the healing techniques of the Temple of the War God, they had been consistent for decades.
"You..."
"Look at his face! Turning purple, struggling to breathe, he's dying! I can buy time until the priest arrives!"
His tone grew more urgent. Sir Flynn halted, staring at the injured person on the ground, then fixed his gaze on Garrett.
This youth was speaking the truth.
That was the gut feeling Sir Flynn had. But just grasping healing techniques and the mention of a '50—50 what-the-heck'—was it effective?
"Captain, trust him!"
Karen squeezed through the crowd. Meanwhile, the patient's struggle became increasingly desperate and feeble.
Sir Flynn made a snap decision.
"What do you need?"
"A needle! A thick, hollow needle!" Garrett answered without hesitation. It was his mistake earlier; clearly, no one understood the '50ml syringe' in this place. Maybe they didn't even have a concept of milliliters. A needle would suffice, right? A thick, hollow needle!
He received blank stares. Garrett didn't lose hope:
"Then a thin metal pipe! None? Iron? Copper? Any damn hard pipe will do! As thick as a pinky!"
"We have it!"
Finally, someone reacted, dashed off, and swiftly returned. What they handed Garrett was something he'd used just the day before—
A chicken leg bone.
Garrett: "..."
Have I been stuck with chicken bones these past few days?
The key was, the day before was a pleural membrane incision surgery, and with a chicken bone in hand, he could directly puncture it. But today, a chest decompression without a syringe, without a needle, trying to stick a chicken bone dozens of times thicker than a needle into the chest?
Do they think I'm Superman?
Garrett roared in his mind. Asking for things that didn't exist; this surgery was turning out to be a series of impossible tasks. He hoped the temple's priests would arrive sooner; otherwise, he wouldn't even be able to contain the infection—
"Give me a dagger! Quick!"
Along the right clavicular midline, second intercostal space, Garrett decisively made a stab. Stab... stab... it wouldn't penetrate!
Are the warriors or knights in this world so physically robust!
"Who'll help me!" Garrett shouted. He measured with his pinky:
"Just... this deep! Stab it! Pull it out, then insert the chicken leg bone!"
"I'll do it!"
Sir Flynn decisively took the dagger.
The knife went in, came out, and the chicken bone followed. A massive pressure released with a hiss, instantly spurting from the bone's center.
Success!
Garrett relaxed entirely. Kneeling beside the patient, he monitored his breathing, listening intently to the airflow in the chicken bone. His thumb rested on the chicken leg bone's tip, occasionally pressing, occasionally releasing.
Post chest decompression, an external one-way valve device should be applied to facilitate the expulsion of high-pressure gas from the chest cavity while preventing external gas from entering. In emergencies, experienced doctors had used surgical gloves, soft plastic bags, or balloons, cut a small hole, and fitted it onto the needle handle, substituting for a valve.
Garrett had no surgical gloves, so he used his thumb, managing the situation on the spot...
With his movements, the bulge on the right side of the patient's chest gradually flattened, and his complexion subtly eased. Anyone could tell that this life had been snatched back from the jaws of death.
"Saved?"
"Saved!"
"It seems like he's really saved!"
"I remember Old Shieko died like this, ribs crushed, and he choked to death in no time. The priest hadn't arrived yet..."
The surrounding soldiers discussed fervently. Sir Flynn's gaze toward Garrett softened, and he proactively asked:
"Little Garrett, what should we do next?"
Next? Insert a drainage tube, perform closed chest drainage, take X-rays, reset the ribs, and if unlucky, open the chest to repair the lungs...
But now, asking for things that didn't exist, I can't do any of these tasks...
Garrett rolled his eyes internally. Fine, if it were in modern times and the emergency department was overwhelmed, they'd pass it to cardiothoracic surgery; but now, in this otherworldly place... ask the priest?
A flurry of footsteps finally echoed. Garrett glanced sideways, the surroundings had already quieted down, everyone saluting, heads bowed:
"Your Grace."
"Your Grace—"
Curious, Garrett turned his head to observe. As for saluting, he was already half-kneeling beside the injured, there was no need to repeat the gesture.
Surrounded in the center was a robust middle-aged man, broad-shouldered, and with a shining bald head.
If you ignored the distinct Western features of a high nose and deep-set eyes, with just this bald head, some might believe it was Lu Zhishen.
A shield was embroidered on the white robe's chest, not in deep brown but outlined in brilliant silver thread. Above the shield, a war hammer and a scepter intersected in a cross.
No other embellishments, just a fist-sized hand holding a scepter, embedded with several gemstones, signifying the esteemed status of the Archbishop.
Around him, seven or eight priests, all muscular men, looked more like warriors than clergy. Among them was the young priest John that Garrett knew, the youngest and thinnest, seemingly only fit to be a priest's apprentice.
The group surrounded the injured. The bald Archbishop glanced at the patient first, then turned to Garrett, eyeing the chicken bone in Garrett's hand. After observing for a moment, he smiled faintly:
"Child, I'm here now. You and your—" He gestured toward the chicken bone, "responsibility can come to an end."
Garrett returned the smile. He was respectful and courteous but also composed, firm, without hesitation:
"Please, proceed with the treatment first. When appropriate, I'll remove it."
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