Chapter 74: Dyspnea (4)

"Doctor! We've moved him to the treatment room!"

As soon as Suhyuk reached the ward station, the shrill voices of the nurses hit his ears.

It almost sounded like a scream, but it was a very natural occurrence.

After all, the patient who had just undergone some invasive procedure was experiencing a drop in blood pressure.

Even if it wasn't a medical accident, it was reasonable to suspect that it was related to the procedure.

"Treatment room. Got it. Daehoon, you go ahead and check on him. I'll follow right behind."

"Y-Yes!"

Daehoon, who had been about to support Suhyuk, immediately ran towards the treatment room.

Fortunately, it wasn't a code blue situation where CPR was needed.

Still, he thought there should be at least one doctor in the treatment room.

Thud.

Thud.

After sending Daehoon ahead, Suhyuk hurriedly used his cane.

[Isn't it time to get faster than this? Aren't you being too lazy with your practice?]

'Shut up, man. Is that something to say to someone with a leg injury?'

[I mentioned it because you get faster when you're angry. Indeed, your speed has increased by about 11%.]

'Oh.'

He was getting faster, but he didn't want to admit it.

It might have been thanks to Baruda.

After all, he had been moving faster since he got angry.

"Hmm."

When he arrived at the treatment room, the patient had already been moved to a bed.

Daehoon, who had arrived first, was holding a tube, looking like he was considering whether to intubate.

But it was clear that he couldn't do it alone.

It would be more surprising if he could.

Intubation in the first week of March for a first-year resident.

If he managed it, rumors might spread that someone more impressive than Suhyuk had arrived.

[Check the vital signs. Daehoon isn't helping at all. Last year, Suhyuk was better than this.]

'This?'

[Let's just move on. He's picked up Suhyuk's tone.]

'Oh.'

How did it come to this, where his only improving skill was making him angrier as time went on?

Well, his diagnostic abilities were improving too.

Anyway, Suhyuk followed Baruda's advice and looked at the patient's vital signs.

'Blood pressure is 90 over 55... the same as the notification I received earlier.'

[The heart rate is 136 beats per minute. It's too fast.]

In comparison, the body temperature and respiratory rate were normal.

To someone else, it might seem like a minor clue.

But for Suhyuk, who had Baruda, it wasn't.

So, Suhyuk memorized the vital signs again and approached the patient.

He already had a stethoscope in his hand, trying to gather more information before any emergency tests were done.

'Breathing... it's rough. What kind of sound is it?'

[Analyzing.]

'How long will it take?'

[It's done. Based on the 12,752 auscultation data points Suhyuk has, the patient has a dull sound in the right lower lobe, and the likelihood of pulmonary edema is 98%.]

'Not pneumonia?'

[There's a 0.9% chance of pneumonia, but considering the normal respiratory rate and body temperature, it's negligible.]

'I see. Now that I listen, it is.'

Medicine requires comprehensive thinking.

It means you shouldn't focus on just one clue but consider everything.

Baruda had developed considerable skills through practice, and Suhyuk had also been trained, so they reached the same conclusion.

'Pulmonary edema. Then what's the cause?'

[It doesn't seem to be bleeding from the kidney biopsy site.]

'Right. The wound is too clean.'

Suhyuk checked the biopsy site, which a nurse was pressing, and shook his head.

It was just clean, with only a tiny needle hole and no signs of bleeding or swelling.

'Bleeding isn't likely to cause pulmonary edema anyway.'

[Then...]

Baruda reminded him of the patient's heart rate.

132 beats per minute.

Almost twice the normal rate.

'Why is it beating so fast if it's not due to blood loss?'

[It could be a problem with the heart itself. Request an EKG.]

'Okay.'

At that moment, a radiologist from the ward pushed in a portable X-ray machine.

Normally, this test should have been done first.

After all, a chest X-ray provides a lot of information.

But not for Suhyuk and Baruda.

They had already concluded it was pulmonary edema.

Moreover, they had another urgent test in mind.

"Wait! Hold on!"

So, Suhyuk stopped the radiologist and tapped the shoulder of the intern standing nearby.

"Doctor, get an EKG right away. It's at the ward station, so bring it here. It's right next to it."

"Ah... Yes!"

The intern didn't hesitate.

Although the radiologist looked unhappy.

But the radiologist left without a fuss.

In contrast, Suhyuk was the dominant one.

Medically right or wrong, it was better to listen to him.

Click.

So, the intern immediately brought the EKG through the side corridor.

Suhyuk was so anxious that he would have carried it himself if his legs were fine, so he and the intern started attaching the EKG leads to the patient.

His eyes were fixed on the EKG monitor.

"Damn it."

As soon as all the leads were connected and a complete EKG appeared on the monitor, a curse slipped out of Suhyuk's mouth.

[T waves are inverted in V4, V5, and V6.]

Suhyuk immediately understood what Baruda meant.

'Cardiomyopathy... Is it an infarction?'

[There's a possibility of infarction, but the probability is low. The patient's age and underlying conditions need to be considered.]

The situation was so urgent that Baruda didn't even crack jokes, just offered opinions.

Suhyuk, too, was in a hurry to form his own opinion based on those opinions.

It was the heart, after all, not some other organ.

'Underlying conditions...'

[Only lupus. No diabetes or hypertension.

If this patient were in their 40s or had diabetes and hypertension, infarction would be the primary concern.

But the patient in front of Suhyuk was only 23.

He wasn't obese.

In fact, he was quite fit.

"First, an echocardiogram! Do you have an ultrasound in the ward?"

"Ah, yes! Should I bring it?"

"Yes. And... I'm sorry, sir! Please wait a moment!"

"No, no, it's fine. Yes."

The radiologist, who had been looking unhappy just a moment ago, couldn't stay that way after seeing the abnormal EKG.

"And we need blood tests! Start with a full lab panel! CK, CK-MB, TnI... and BNP."

"Yes, Doctor!"

Even if there were any complaints, the atmosphere didn't allow for them.

The treatment room was as chaotic as a battlefield.

Suhyuk, standing in the middle and directing everything, seemed too skilled to be just a second-year resident.

'Indeed... this person...'

Daehoon looked at Suhyuk as if he were a god.

Meanwhile, some blood was drawn by a nurse, and the intern arrived with the ultrasound machine.

"Yes, Professor. I'll check the ultrasound now."

"Okay! I'll be right there!"

"Yes."

Seizing a moment of free time, Suhyuk ended the call with Shinhyuntae and took the ultrasound.

He then squeezed some gel and placed it on the patient's heart.

Thump.

Thump.

The heart, which looked weak, appeared on the screen.

It wasn't just a feeling; the heart's movement was definitely abnormal.

'The overall movement is reduced.'

[The analysis shows no specific area with significantly reduced movement.]

'So it's not consistent with an infarction. What about the ejection fraction?'

[The CPU in the echocardiogram is much less advanced than Baruda. We need to wait.]

'You... even in this situation... Oh, my.'

The patient's ejection fraction was 15%.

A clear indication of heart failure.

The patient was only holding on because of his young age.

Otherwise, he would have likely passed away by now.

'The EKG is abnormal, the heart movement is reduced on the ultrasound, and the likelihood of infarction is low.'

[There was no recent head trauma, no pheochromocytoma, and no cerebral hemorrhage.]

'So...'

[Takotsubo cardiomyopathy can be suspected.]

Based on the evidence gathered from the treatment room, Baruda presented the most logical diagnosis.

They had concluded that the cause of the low blood pressure was not bleeding from the kidney biopsy but a heart-related cause leading to pulmonary edema.

Through the EKG, the patient's underlying conditions, and the ultrasound findings, they determined that the heart failure was due to a cause other than infarction.

Specifically, takotsubo cardiomyopathy.

"Damn it."

Suhyuk couldn't help but curse.

Takotsubo cardiomyopathy might sound like nothing, but in cases where heart function is severely reduced, it can be a life-threatening condition.

"First... Dopamine! To the cardiac ICU! Daehoon! Contact the professor! Tell them we're going to the ICU!"

"Yes, yes! But, what should I tell them about the diagnosis...?"

"Tell them it's takotsubo cardiomyopathy, EF 15%! They'll come running!"

"Yes!"

"Okay. Let's go down! Are the blood test results in?"

Suhyuk, without his cane, pushed the bed and asked.

The intern and nurses were all in agreement, and one of them turned to Suhyuk.

"Yes! The... everything else is fine, but the cardiac enzymes, including CK, are elevated!"

"That's expected. What about the others?"

It's not cardiomyopathy.

The heart muscle is being destroyed, so it's inevitable that the enzymes inside are leaking into the blood.

"A, the liver function tests are in! AST/ALT are 2022 and 2617!"

"Oh. This is really..."

Heart failure is scary for this reason.

Water could start filling the lungs of a healthy adult.

The liver could start to necrotize.

If this state persisted, it would inevitably lead to multiple organ failure and death.

[Based on the current situation, I will analyze the optimal treatment method. I won't be able to talk for a while.]

Recognizing the severity, Baruda entered analysis mode.

Suhyuk, unable to thank Baruda, pushed the bed.

"How... how did this happen?"

Until he met Shinhyuntae, Suhyuk didn't say a word.

"The patient's blood pressure dropped... I examined and found pulmonary edema. I suspected takotsubo cardiomyopathy from the EKG, which showed T wave inversions from V4 to V6. The echocardiogram also showed consistent findings, so we started dopamine and came down."

"Ah."

Shinhyuntae wondered if such a diagnostic process was possible for a second-year resident.

Lee Hyunjong, who had rushed over after hearing the call for help, felt the same way.

'Really a shame.'

If Suhyuk's legs were fine, he would have been snatched up by the cardiology department immediately.

Lee Hyunjong, after finally looking away from Suhyuk's legs, faced Suhyuk.

"So, what's the plan? Keep the dopamine going?"

He asked out of genuine curiosity, not to test Suhyuk.

Of course, Suhyuk couldn't answer immediately.

'Hey, not yet?'

Baruda was silent.

'Hey, hey.'

[One minute. Just one minute. You talk a lot, don't you?]