Tension pneumothorax occurs when a large lung bulla ruptures, or when a large, deep pulmonary laceration or bronchial rupture occurs. The tear connects to the pleural cavity and forms a one-way valve. It is also known as high-pressure pneumothorax.
Once tension pneumothorax develops, the pressure inside the pleural cavity drops during inhalation, opening the valve and allowing air to enter the cavity. During exhalation, the pressure rises, closing the valve and trapping the air inside.
The more the patient breathed, the higher the pressure in the pleural cavity climbed, crushing the lung. Eventually, the lung would be completely compressed and unable to expand...
No matter how desperately the patient tried to breathe, he couldn't draw in a single breath.
This was one of the deadliest emergencies. Apart from a slash to the carotid artery or a rupture of the aorta somewhere in the chest or abdomen, no other internal bleeding could kill as quickly.
Death by suffocation was only moments away.
A priest?
The Temple of the God of War was indeed right beside the military camp. Someone could sprint over and back in five minutes at most. But the patient lying on the ground couldn't wait five minutes!
"50 ml syringe!"
Gret shouted.
No one responded.
Nobody handed him anything. There was no syringe, no needle, no drainage tube...
Nobody knew what he needed, why he was doing this, or even what the wounded man's symptoms meant.
This was another world, not his hospital, not the emergency department where he'd worked for over a decade.
Gret looked around. Anxious faces surrounded him, watching the patient and staring toward the nearby temple, hoping a priest would come running. Some were even calling for a door to be taken off its hinges or a large shield brought over, so they could carry the wounded man to the temple...
By the time you got him there, he'd be dead!
Gret panicked. He threw himself in front of the wounded man, one arm spread wide, the other reaching out to grab Knight Flynn.
"I'm a healer! I can save him! Captain, help me!"
"You can save him?"
Knight Flynn stopped in his tracks. Gret nodded hard.
"He's dying! I can save him! I'm missing something, Captain. Help me!"
Knight Flynn hesitated.
He'd just heard from Captain Karen that Gret had learned healing magic. But no matter how much he trusted Karen, hearing about it wasn't the same as seeing it with his own eyes.
Besides, they'd seen the Temple of the God of War's healing magic with their own eyes for decades.
"You..."
"Look at his face! It's purple, and he can't breathe. He's dying! I can buy him some time! Keep him alive until the priest gets here!"
His words came faster and faster. Knight Flynn halted, glanced at the wounded man, then fixed his gaze on Gret.
The boy was telling the truth.
Knight Flynn's instincts told him so. But healing magic he'd only just learned—and that thing he'd said about "50" and "50"... whatever that meant—would it really work?
"Captain, trust him!"
Karen pushed through the crowd. At the same time, the wounded man's struggles grew more frantic—and weaker.
Knight Flynn made up his mind.
"What do you need?"
"A needle! A thick, hollow needle!" Gret answered without hesitation. That had been his mistake. Nobody in this place would understand "50 ml syringe." Maybe they didn't even have the concept of milliliters. But surely they knew what a needle was! A thick, hollow needle!
Everyone shook their heads. Gret didn't lose heart.
"Then a thin metal tube! You don't have one? Iron? Copper? Any hard tube will do! About as thick as my little finger!"
"We have one! We have one!"
At last, someone understood and ran off. A moment later, he returned and handed Gret something he'd used just two days ago, something very familiar—
A chicken leg bone.
Gret: "..."
Was I really going to be dealing with chicken bones every other day?
The problem was, the other day he'd performed a cricothyrotomy. He could simply push the chicken bone straight in. But today he had to perform a thoracic puncture decompression. With no syringe or needle, he was supposed to stick a chicken bone dozens of times thicker than a needle into someone's chest?
What did you people think I was, Superman?
Gret roared inwardly. Once again, he had none of the things he needed for the procedure. He could only hope the priests got here quickly. Otherwise, he couldn't even prevent an infection—
"Give me a dagger! Quickly!"
Second intercostal space, midclavicular line on the right. Gret thrust the dagger in without hesitation. He stabbed... stabbed... but couldn't get it in!
Were the warriors—or knights—of this world really that tough?
"Someone help me!" Gret shouted. He showed them a depth with his little finger.
"Just... this deep! Push it in! Pull it out, then put the chicken bone in!"
"I'll do it!"
Knight Flynn took the dagger without hesitation.
In went the blade, then out. The chicken leg bone slid in after it. Pressurized air hissed out of the hollow bone in a sudden burst.
It worked!
Gret relaxed all over. He knelt beside the wounded man, watching his breathing and listening closely to the airflow through the bone. He covered the top of the chicken leg bone with his thumb, pressing it down and lifting it in turn.
--After decompressing the chest, you should attach a one-way valve to let high-pressure air escape from the chest while preventing outside air from entering. In an emergency, doctors in the past had used a surgical glove, a soft plastic bag, or a balloon, cutting a small hole and fitting it over the needle hub as a makeshift valve.
Gret didn't even have a surgical glove. All he could do was use his thumb and control the rhythm himself...
As he worked, the bulge on the right side of the wounded man's chest gradually subsided, and his complexion slowly improved. Anyone could see that Gret had pulled the man back from the brink of death.
"He's saved?"
"He's saved!"
"Looks like he really is!"
"I remember Old Xieke died the same way. His ribs were smashed, and he was gone in no time. The priest hadn't even arrived yet..."
The watching warriors murmured among themselves. Knight Flynn looked at Gret with much warmer eyes and asked him directly:
"Little Gret, what do we do next?"
Next? Insert a drainage tube, perform a chest tube drainage, take an X-ray, set the ribs, and—if they were unlucky—open the chest to repair the lung...
But they had none of the necessary equipment. He couldn't do any of that...
Gret rolled his eyes inwardly. Fine. In the modern world, if the emergency department was swamped, they'd hand the patient over to thoracic surgery. Here in another world, he'd just have to... call a priest?
At last, a great many hurried footsteps rang out. Gret glanced to the side. The people around him had already dropped into a sea of bows, heads lowered as they greeted the newcomers:
"Bishop."
"Bishop—"
Gret turned his head curiously to look. As for bowing, he was already kneeling beside the wounded man, half a head shorter than everyone else, so there was no need to make a fuss about it.
The man surrounded by the crowd was middle-aged and powerfully built, broad-shouldered, with a massive, gleaming bald head. If you overlooked his Western features—the high nose and deep-set eyes—you could easily believe that this bald man was Lu Zhishen.
A shield was embroidered on the chest of his white robe, too, but this one was outlined in brilliant silver thread rather than dark brown. A war hammer and a scepter crossed over the shield.
He wore no other ornaments. Only the scepter clutched in his large fist, its top studded with several gems, marked him as a bishop of great standing.
Seven or eight priests of all sizes crowded around the bishop. Every one of them was muscular and looked more like a warrior than a member of the clergy. Young Priest John, whom Gret knew, was among them. He was the youngest and the thinnest, and was clearly fit only to be a priest apprentice.
The group surrounded the bishop as they approached the wounded man. The bald bishop's first glance went to the patient, and his second to Gret and the chicken bone in his hand. After observing for a moment, he smiled faintly.
"Child, I'm here. You and your..." He pointed at the chicken bone. "...can finally be relieved of your responsibility."
Gret smiled back. His tone was respectful and polite, yet calm and resolute. He answered without hesitation:
"Treat him first. When the time is right, I'll pull it out."
Before you continue