"Dr. Zhao?"

The emergency room nurse, Wang Li, stood by, waiting for Zhao Heng's instructions.

As an emergency room nurse, it's fair to say that scenes like this play out several times a day.

"Four units of Sodium Nitroprusside, 0.5 Esmolol bolus over 1 minute, maintain for 10 minutes."

Upon seeing the glaring red blood pressure numbers on the life monitor, Zhao Heng quickly made a decision.

This Sodium Nitroprusside is the drug of choice for hypertensive crises; it is a short-acting antihypertensive medication. Its nitroso groups decompose to produce NO, causing vasodilation, and it can dilate both arteries and veins.

As for Esmolol, it is a selective β-receptor blocker, mainly used for tachycardia and hypertension during anesthesia induction, tracheal intubation, intraoperatively, during anesthetic recovery, and postoperatively.

The reason Zhao Heng chose the combination of Sodium Nitroprusside and Esmolol was, on one hand, to quickly lower the blood pressure, and on the other, to stabilize the patient's heart rate, preventing arrhythmias.

It's fair to say that unless one is a seasoned emergency physician with decades of experience, such a comprehensive emergency blood pressure-lowering plan would be unimaginable.

"Alright, Dr. Zhao."

Upon hearing Zhao Heng's instructions, Wang Li immediately responded.

However, at this moment, Wang Li noticed a calm demeanor in Zhao Heng usually only seen in senior doctors.

In no time, Wang Li prepared the two medications and began injecting them into the patient.

Once the medication entered the patient's veins, it took effect immediately.

230/120

200/100

...

Three minutes later, the blood pressure dropped to 140/80mmHg; this blood pressure, at borderline hypertension, was now out of the hypertensive crisis.

"Senior, you can start the operation."

Seeing the blood pressure safely stabilize, Zhao Heng couldn't help but breathe a sigh of relief and said to Liu Ziang.

"Alright."

Liu Ziang nodded.

He never doubted Zhao Heng's ability to handle emergencies.

Every time, Zhao Heng never let him down.

"Let's begin."

Liu Ziang said to Li Yang and the two firefighter gentlemen.

Next, Li Yang wrapped both ends of the rebar with cloth and then, with Liu Ziang, held each end of the rebar with their hands.

Meanwhile, the two firefighters, one used a hydraulic breaker to secure one end of the rebar, while the other held an angle grinder, gradually cutting the rebar, producing continuous sparks and a buzzing sound.

Soon, the part of the rebar sticking out of the laborer's head was cut off.

The process looked extremely thrilling.

Once the portion protruding from the head was cut off, the laborer uncle was immediately taken to the CT scan room for a brain examination.

Ten minutes later.

At the CT scan operation desk.

The laborer uncle's head was already wrapped in thick bandages, and he lay on the examination table, ready for a brain CT scan.

Zhao Heng and Liu Ziang stood behind the operation desk, watching the real-time brain images appearing on the electronic screen.

"Director Liu, this patient is very lucky. The rebar is only 0.5mm away from the middle cerebral artery."

The radiologist, Xu Jin, looked at the brain CT image displayed on the electronic screen and said somewhat amazed.

"Certainly lucky, otherwise, he wouldn't have made it to the hospital."

Liu Ziang nodded.

Actually, each year, there are quite a few accidents on construction sites, and it's not uncommon for workers to be penetrated by rebar.

There are always a few lucky ones who survive being pierced through the abdomen, chest, or even the head by rebar.

At that moment, Zhao Heng noticed something amiss on the image on the electronic screen.

"Teacher Xu, can you enhance this area?"

Zhao Heng pointed to an area on the screen where the brain tissue density was significantly reduced.

"This area?"

Xu Jin was a bit puzzled, then looked in the direction Zhao Heng pointed.

"This... this is the brainstem area."

Just with a brief glance, the experienced Xu Jin was somewhat surprised.

The brainstem primarily functions to maintain vital life functions, including heartbeat, breathing, and digestion, all of which are related to the brainstem.

So, typically, lesions rarely occur in the brainstem area.

And if a lesion does occur, the situation is extremely severe.

"However, this low-density shadow could sometimes be due to brainstem degeneration, which may not have clinical significance."

Xu Jin thought for a moment and then said.

"No, this is not brainstem degeneration; it's a brainstem glioma!"

Looking at the area Zhao Heng pointed to, Liu Ziang said with a very grave expression.

"It couldn't be, right?"

Xu Jin was somewhat taken aback by Liu Ziang's judgment; brainstem gliomas are extremely rare.

"It's very possible. The co-workers who brought the patient mentioned that he fell from a two-meter-high scaffold. For an experienced worker, two meters aren't a very high height. So, it's highly possible that the patient had a sudden bout of dizziness, leading to his fall. Moreover, in the later stages of a brainstem glioma, cranial nerve palsy can also cause unsteady gait and ataxia, all of which could have contributed to the patient falling directly."

Zhao Heng pondered for a moment and said.

Back in the emergency room, Zhao Heng was already puzzled about this laborer uncle's injury.

For someone who has long worked on construction sites, two meters isn't considered a very dangerous height.

Many operations are carried out at heights of several meters or even dozens of meters.

Two meters is quite ordinary, and with such a height, if an accident causes instability, a person still has some reflex capacity; they wouldn't just topple backward, falling headfirst into rebars penetrating their head.

"..."

At this moment, Xu Jin was at a loss.

Having a penetrating head injury and still being able to be taken to the hospital was already a miracle.

And now they even discovered a brainstem glioma!

The brainstem tumor has long been considered a "no-go zone" for surgery because the brainstem contains many nerve nuclei, conduction pathways, and reticular formations in a small area.

Brainstem tumors are mostly infiltrative gliomas, making surgery very difficult, prone to causing damage to essential structures within the brainstem, and surgery has a high rate of disability and mortality, with a poor prognosis.

Adding these together, Xu Jin didn't even know how this surgery should be performed.

"Junior, do you have confidence in the anesthesia aspect?"

Liu Ziang asked Zhao Heng with a serious expression.

Given the patient's condition, safely extracting the rebar from the head was already challenging enough.

Not to mention, they would also need to simultaneously remove the tumor located on the brainstem.

The more daunting issue is that the brainstem controls the body's vital functions like breathing and heartbeat. Performing surgery on the brainstem makes the patient susceptible to respiratory or cardiac arrest at any moment, highlighting the exceptional difficulty of providing anesthesia and maintaining the patient's normal vital signs.

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