Chapter 2571: Boss Mode

What is the main working principle of a pacemaker?

It emits pulses to stimulate the heart muscle, causing it to contract and relax.

When should a pacemaker emit pulses to save a patient’s life? Based on the different clinical needs of patients, pacemakers have different working modes. The excessively detailed modes won’t be described, only broadly distinguishing the two main categories. One is the asynchronous mode, which means the pacemaker stimulates the heart’s ventricles or atriums with a fixed pulse regardless of the patient’s own heartbeats, abbreviated as VOO or AOO mode. What is the advantage of this mode?

"During surgery, an asynchronous mode is used to enforce pacing, thus avoiding interference from the Electrosurgical Unit that could trigger ventricular fibrillation in the patient," Xie Wanying said.

Simply put, when the Electrosurgical Unit is in use, it can interfere with the pacemaker’s sensing signal system, so a fixed mode without a sensing signal system must be used during surgery.

After the surgery, when the Electrosurgical Unit is no longer used, generally, the fixed mode is no longer needed. This is because this mode has obvious drawbacks. How so? Xie Wanying continued, "When I came over earlier, I noticed it didn’t quite look like ventricular fibrillation; if it were at a rhythm to induce ventricular fibrillation, I’m afraid the pacemaker hadn’t switched from the fixed mode back to other modes. After checking, that was indeed the case, so I quickly switched the pacemaker back to other working modes. Thus, her ECG stabilized."

Simply explained again: Xiaohui’s condition improved, and the newly installed heart finally returned to normal functioning. If a fixed mode were used at this time, the pacemaker wouldn’t be able to sense the heart’s intrinsic rate. Once the restored heart’s spontaneous rate exceeds the fixed pacing rate of the pacemaker, both would compete in frequency, ultimately inducing ventricular tachycardia or fibrillation, endangering the patient’s life.

Upon hearing this, everyone finally understood the sequence of events. Student Xie neither performed internal cardiac compressions on the patient nor needed to, simply adjusting the pacemaker mode resolved the alert crisis.

Doctor Yao turned back and asked Dr. Han, "Didn’t you switch back to other modes when you returned?"

"I did." Dr. Han denied, confident that such a lapse wouldn’t be their mistake or that of their team.

The patient has multiple devices and tubes, could it be that at some point something accidentally pressed the pacemaker button causing an issue? It’s hard to say. Clinically, we often encounter these seemingly eerie situations. The most important thing is, when a danger is detected, to make accurate judgments and troubleshoot the problem, which is the on-duty doctor’s responsibility.

Doctor Yao’s blame on the intern was actually unreasonable from beginning to end.

As she said herself, if she thought the intern was unsuitable for the operation, she should have immediately rushed into the ward to stop the intern. Instead, her failure to immediately arrive on the scene to carefully assess the patient’s condition was a dereliction of duty.

"You said she did it wrong, yet you didn’t stop her?" Cao Zhao confronted Doctor Yao, the small whirlpool in his dark eyes seemed bottomless.

"I, I was—" Doctor Yao couldn’t find an excuse, sweating continuously, not being able to admit to being outmatched by a medical student.

Mu Yongxian told the people in the PICU, "Go get your chief over here."

The bosses always have no need to argue with others, it’s the others who argue and argue, then suddenly reach out overwhelmingly putting others in their place.

The students on site learned that to discipline someone, you must use Boss mode.

Doctor Yao never imagined that one day she would become a big news sensation in the hospital. What big news? Two major competing pillars, who seemed irreconcilably opposed, actually joined forces to instruct her.