Chapter 36

Even if amputation was performed on-site, Yang Ping did not want to make it a hasty affair.

The miscellaneous items around them were cleared away, and a waterproof pad placed under the thigh.

Little Five worked methodically and swiftly. As Yang Ping’s assistant, he strived to meet the standards.

A sterile package was opened, disinfected, and a sterile bottom sheet and hole towel were laid out.

“Syringe, 10% lidocaine, saline water, dilute one to one!” Little Five had already handed these items over.

Without an anesthesiologist, only local anesthesia could be administered.

Amputation under local anesthesia? What high level of local anesthetic technique was required! Dr. Lv from the emergency department broke out into a cold sweat.

Local anesthesia is generally used for minor surgeries, like suturing small wounds or removing small tumors. Too small a dose might not achieve the desired effect; a dose too large might risk anesthetic poisoning. One hospital had a patient die from anesthesia poisoning in the outpatient operating room after overdosing on local anesthetic during the removal of a tendon sheath cyst on the hand’s back.

Hence, even slightly larger operations, such as larger wound sutures, wouldn’t typically use local anesthesia due to the higher risks and subpar effects.

Now Yang Ping was using local anesthesia for an amputation? This surprised everyone.

Although local anesthesia seems simple, it too is a technical job. Ordinary local anesthesia involves injecting the drug around the surgical area; a more accurate method is to block the nerves that control the surgical area.

The latter is called nerve block, which is a more advanced form of local anesthesia. If we were to use an analogy, the former would be compared to blindly firing a cannon at enemy lines, while the latter would be like using precision-guided missiles to obliterate enemy bases.

To master nerve block anesthesia, one must be very familiar with anatomy, understand the nerve control in each region, and familiarize themselves with the nerve pathways.

Now, Yang Ping was about to block the right femoral and sciatic nerves.

Anesthesiologists usually use surface ultrasound for positioning for this kind of block, but Yang Ping now had to do it manually.

Dr. Lv watched intently and with anticipatory admiration–amputation under local anesthesia.

Following the pathway of the femoral and sciatic nerves, Yang Ping first blocked the femoral nerve–starting from the skin on the upper part of the thigh and anesthetizing layer by layer. As he carefully inserted the needle into the nerve sheath, the feeling of electric shock immediately emanated.

“Feeling like an electric shock?”

“Yes!” The patient said with gritted teeth.

Then, the medication was injected into the sheath of the nerve.

The same method was used to block the sciatic nerve, whose branches primarily control the skin’s feeling in the lower limbs.

Just as the transmission of current along a wire is interrupted, the nerve impulse was successfully blocked by the anesthetic.

The effect was very good. After a short wait, the patient’s right lower limb had no sensation, and Yang Ping began to make the incision.

The knife formed a beautiful tongue flap—skin, subcutaneous tissues, deep fascia, muscles, blood vessels ligation, high-level nerve incision, exposing the femur and sawing it off mid one-third with a wire saw. The fracture site of the femur was lightly rounded off.

The same method was used to cut a tongue flap from the skin, deep fascia, and subcutaneous tissues on the opposite side.

The bleeding site was ligated one by one, leaving the surgical area clean.

The amputation was completed in less than five minutes, perhaps even shorter. The stump was wrapped in a sterile sheet, with the remaining treatment to be continued on the ambulance.

The EMTs quickly lifted the patient onto the stretcher, put on a nasal cannula, continued with cardiac monitoring, and swiftly connected various tubes and wires before tidying up.

The stretcher was placed in the middle, with Yang Ping and Little Five on one side, Dr. Lv and the nurse on the other.

The vehicle started, heading for Sanbo Hospital. To save time, the driver chose the quickest route on the GPS.

Lidocaine local anesthesia can last one to three hours. The anesthetic was still effective, and the patient felt no pain. Dr. Lv was thinking – if he could master Yang Ping’s superb nerve blocking technique, there would no longer be a need to use morphine for pain caused by injuries in future emergency situations. A direct high-selectiveness nerve block would make the journey to the hospital painless for patients.

In the ambulance, within the limited space, Yang Ping and Little Five carefully washed the amputation stump. After disinfecting and laying sheets again, they stitched together the muscles, fascia, and skin. Only then was the amputation considered complete. This too took only a few minutes.

“Doctor, can I survive?” The patient’s voice was already very weak, his face and lips were pale, his eyes were closed and he struggled to open them slightly.

They had turned the IV to the fastest rate possible, simultaneously giving infusions through three channels, colloids, crystalloids, entering the body.

Yang Ping was tightly holding his hand. It was ice-cold.

“You can! You definitely can!”

The patient gasped, still wanting to talk, but was unable to gather the energy to speak several times.

“Don’t talk anymore, you’ll be alright, hang in there!” Yang Ping held the patient’s hand, squeezing it a bit to offer encouragement.

Still, the patient managed to squeeze out a few words: “Save — me — my child — junior high school — pitiful –”

Words have become sparse and discontinuous.

The ambulance is quite advanced, but it is still just an ambulance, only providing basic life support such as fluid resuscitation.

In the short term, fluids can maintain volume, but ultimately it will require a blood transfusion to replenish red blood cells and maintain oxygen transport. And transfusions can only be done at the hospital.

Heart rate has already risen to 120 per minute, blood pressure has dropped to 80/40mmHg, and oxygen levels are barely maintained at 90% with oxygen inhalation.

No one knows whether the burgeoning spleen has ruptured. If it has, it’s a sure death. Sometimes you have to admit it’s all down to luck.

Dr. Lv can’t perform a surface ultrasound anymore, as applying pressure with the probe also carries a risk. Even if a rupture is identified, there’s still nothing that can be done for now.

“Hurry!”

Yang Ping said to the driver in front, his hand clutching the patient’s, his fingers continuously pressing on the radial artery. The pulse was weak, seemingly about to disappear.

“We’re already going as fast as we can!” shouted the driver, yet his foot pressed harder on the accelerator.

The nurse switched out another bag of fluid. Dr. Lv was on edge, his face covered in sweat.

The ambulance siren was urgent, and the driver danced through the traffic. Some cars moved aside to make way, but most others simply ignored it. The driver, a retired armored driver, was very skilled and calmly handled the steering wheel, constantly overtaking other cars.

The biggest unpredictability of urban traffic is jams.

Everyone in the car was praying, begging the traffic gods for no congestion, just not now!

The patient was now delirious, and a shout would only cause a slight flutter of the eyelids.

The ambulance got onto the overpass. Suddenly, the car in front braked, slowed down, and stopped gradually.

The ambulance followed suit, slowing to a stop. Because the ambulance had maintained a good distance from the car ahead, the stop was smooth and didn’t jar the patient too much.

“What’s going on?” Little Five asked.

The driver shook his head: “I’ll go and check.”

Immediately, a long line of cars formed behind them, and looking forward, a long snake of cars stretched out ahead as well.

The driver pulled the brake, opened the door, and got out. He walked about ten meters forward to investigate the situation.

He came back and said, “A truck broke down up ahead. It’s caused a traffic jam.”

Damn! Everyone cursed.

Stuck in traffic at a time like this, it was a hopeless situation. Cars were packed tight on all sides, there was no way to move forward or backward.

Yang Ping’s heart sank, and the pulse in his hand was nothing but a faint whisper, like a candle in the wind, about to go out.

The flame of life can sometimes be very tough, but at other times it’s extremely fragile, easily extinguished by the slightest disturbance.

Dr. Lv opened the ambulance’s back door. He shaded his eyes with his hand and looked ahead to the endless snake of traffic, looking back, the snake still continued in winding coils.

He walked back and forth behind the ambulance, his right fist smashing into his left hand, nervousness etched on his face.

Time was slipping away, second by second.

The patient was completely out of it, no longer even stirring when called. His pulse rate was increasing rapidly, his pulse as faint as a gossamer thread, and on the verge of disappearing.

After looking again and again, with the traffic completely stationary, Dr. Lv lifted his head and let out a heart-wrenching cry: “Help! There’s someone in the ambulance who needs urgent help!”

Even if they called for a helicopter right now, it would be too late. And not everyone has the chance to be airlifted. Of the two helicopters that the hospital had, one was undergoing maintenance, and the other was hired by a high-end insurance company to transport another patient.

The piercing siren of the ambulance, the flashing lights, and the desperate cries of the doctor attracted the attention of other drivers who had got out of their cars for air. A fellow wearing sunglasses squeezed through the narrow gaps between the cars and asked, “What’s going on?”

“The person in the ambulance is dying. They won’t make it much longer,” Dr. Lv said helplessly, wiping sweat off his forehead with his sleeve.

Inside the vehicle, Yang Ping and Little Five watched over the patient. Little Five stared at the heart monitor while Yang Ping continued to hold the patient’s hand.

The man in sunglasses scratched his head, took off his sunglasses, peered in, then looked at the traffic jam.

Then he raised his voice:

“Quick, quick, quick! Come help, emergency! Someone’s life is at stake!”