Parallel World Pharmacy

Palais and Blanche of the de Medicis family, and their servants, Catherine and Lotte, were rocking in the carriage. Outside the window of the carriage, you can see the dark, drooping sky. Lotte was lying in the carriage seat and accompanied by her mother Catherine. In the meantime, Lotte's consciousness has become clearer.

She gives a weakly plundered groan and brings a lid, but doesn't seem to have enough strength to wake herself up.

"You, you! Did you wake up?... thanks to Lady Palle and Lady Eleonor."

"Mother... this place"

Katrine, who was about to give up Lotte's recovery, hugs her daughter, crying and swallowing with joy. Across the street from them were Palais and Blanche, watching the interaction between them.

"Lotte, good for you. Thanks for your help, I was wondering what to do."

"Dear Blanche..."

Blanche jumps to Lotte and rejoices in his recovery. Palle, who, together with Ellen, succeeded in the ban and resurrected Lotte from the abyss of death in exchange for half her life expectancy, gave Lotte a reassuring look at his return to consciousness.

Lotte is getting a supplementary explanation from Katrine for the interaction between the two of them. She really didn't seem to have a complete memory for a few days.

It is believed that he was possessed by evil spirits and wandered the frontiers of life and death. Pallet cares about Lotte's condition, which has become slightly smaller, as she snuggles around her eyes for mild dehydration.

"You can stay asleep, give him a little check-up."

Pallet put a cane on Lotte's arms and lower limbs to check for deep and superficial reflections. Modern medicine combined with divinity gives some idea if the reflexes are normal. In addition, check blood pressure, pulse rate, body temperature, etc. And when I took out the glass, I created the generative water with divine art, mixing in it the mystical drug that would get Lotte in shape, and I gave it to her by divine art.

"You have a slight fever, but it doesn't seem to be a problem for one second. It's a good medicine, take it. So, Charlotte, how far on earth do you remember this?

"Ya... but I think I was at the pharmacy. After that, I needed a customer who looked weird. I'm not sure, but did Master Palle help you? Um, thank you."

"Also say thank you to Eleonor. I hope to see you again."

"I'll see you! Big brother, when you get up there, don't say anything weird."

Blanche argues to Palle that it's not even an edge. Think of Ellen, who remains in the pharmacy of the Evil Spirit swirling imperial capital, or Beatrice, who is staying in the mansion trying to protect the absence of the de Medicis family instead of our Lord Bruno, who seems to be a little nervous.

"Um, Master Palle. Why is Master Eleonor here now?

"... Lotte, shut up"

Mother defied Lotte, who questioned Palais frankly.

"Where are we going?

"The imperial capital is occupied by evil spirits and citizens are evacuated to the city of Lambue. Send you guys to the evacuation site and I'll be back in the capital."

"Dear Palais, It's dangerous, the Empire is no longer..."

"Shut up, Katrine. Whatever the opponent is, I don't like running away from my enemies."

"But if anything happens to you, the House de Medicis... as does Master Beatrice"

"But both my mother and father stayed. If you just wrapped your tail around it and ran away, the house would only be slowly doomed. The outbreak and spread of evil spirits is similar to that of epidemic diseases. Growing evil spirits call for further evil spirits, which expand rapidly. If, then, we do not put an end to the tragedy in the Imperial capital and stay in the endemic (local epidemic) stage where epidemics are referred to, in time the world will be swallowed up by evil spirits. Then no one will be able to live."

"Dear Palais..."

"What will you do without fighting until you run out of divine power? That is the statute of those who were chosen as patron saints."

Palle proclaimed that he was obedient to Beatrice's instructions and honestly didn't seem to intend to evacuate the servants after they were able to ensure their safety.

"Brother, me too!

"You've got your feet together, Blanche. You didn't come prepared for the day to come. You, along with the men of the Mansion, will be able to evacuate to the city of Lambue, protect the people close to you and the citizens, and if the bond of the Guardian Temple of the city of Lambue is still functioning, you will be able to do enough to drive away the little evil spirits. I still want to go back, but only after I've fulfilled my promise to my mother."

"... my brother... he's going to die."

"I'm in trouble. That's the part about you, your father and your mother."

Katrine included the temptation in her words, but she did not deny it.

The carriage line of the de Médicis family, which carries them with various thoughts, travels at full speed towards the city of Lambue.

…━━…━━…━━…

Pharma loosens a corset or belt of neat Ellen's clothes and lays a sheet of clean plastic on the floor.

Sleep her horizontally on top of it, gauze on her wound back, blanket and keep warm.

The store at the pharmacy was cold, so I put a fire in the fireplace to keep the room warm.

"Heart rate is up, blood pressure is down. Bleeding between 1L and 1.3L?"

Using the diagnostic eye, Pharma organizes in his head what he is going to do.

Initial infusion will be performed on the hemorrhagic shock to restore blood pressure.

Humanity wants to stop the bleeding first, but even if the bleeding continues, it's the first infusion.

If the bleeding causes your blood pressure to drop, it won't help either. If blood pressure stabilizes, maintain the infusion, or transfusion if bleeding volume is high, and then finally get into hemostasis.

He estimates the severity of the bleeding shock.

"Estimating Ellen's weight at 50 kg, the circulating blood volume is 1/13 of her body weight, or 3.85 kg. The bleeding volume may have subsided within 35% of the critical mass or exceeded."

Applying it to the index of bleeding shock index as I say bumps, the severity is estimated to be three or the largest amount of bleeding out of four stages, four. It's a tough situation, but it's at least a rescue that this is a medication and a well-equipped pharmacy.

Pharma jumps into the pharmacy dispensary and gathers the infusion set.

Since the milk selling boy with type I diabetes was always prepared for when he fell into ketoacidosis, the lactate ringel, acetate ringel and bicarbonate ringel solution were in ready condition for use and the infusion into other emergencies was also assumed to be ready. Ellen's blood type has been pre-tested for items such as blood type and irregular antibodies, and blood is collected on Monday to store whole blood refrigerated. Ellen's self blood should be stored in optimal condition if she handles it as per the manual.

There are also frozen preserved red blood cells and plasma components.

Once the water has been sprinkled in a pan in the dispensing room, and the infusion bottle containing Lingel acetate solution can be heated to about 39°C at the right temperature with water, treatment begins.

"Do we have to..."

Even one more person on this occasion would have made a dramatic difference had there been a person to lend a hand.

The treatment alone is full of anxiety.

But all the preparations come back ”then”.

"Calm down. I'm not in the same condition as before."

Previously Pharma, from the point of view of being a pharmacist, drew a line that medicine should not be involved, and was just a step away from the clinical. In this world, however, he has experienced several cases as a clinical pharmacist in a situation where there is also an eye consultation aid and no substitution, and he has been present with not less than Claude's autopsy and surgery.

Experience is gaining a little bit.

We just have to do it, illuminating the updated findings and the skills at hand.

Face reality.

First, tactile the artery.

The common carotid artery is palpable, but the radial artery of the wrist is palpable. Pharma rips Ellen's skirt. I can't stand idle to save my life. Palpate the femoral artery in the radius. At this point, empirically, the blood pressure will be between 70 and 80 mmHg.

To secure the peripheral venous tract, tie your arms and look at your arms and back of your hand (back of hand). Peripheral veins are generally depleted and circulating blood volume decreased by decreased blood pressure, making it difficult to see blood vessels. Nevertheless, two or more peripheral venous paths must be secured with a retaining needle with an inner diameter of approximately 1 mm, equivalent to 18 gauges.

Once unsuccessful, he managed to penetrate the radial cutaneous vein with a needle, affixing the film from the top to the venous retention needle penetration and securing it as the first route.

The other was punctured by a thick vein, the femoral vein, ready for rapid mass administration into the venous tract.

"Back me up."

Initiate administration of Lingel acetate solution as an initial infusion into the venous tract. I'd like to use a bicarbonate ringel that improves my acidosis from the beginning, but I reject it in an emergency where I'm forced to deal with it alone because I have to fill up carbon dioxide before I can use it. The next best Ringel acetate solution is isotonic electrolyte solution, which should replenish the extracellular fluid when circulating blood volume decreases and, above all, restore blood pressure. I would also like to add, for example, hydroxyethyl starch (HES), which is a substitute plasma drug, but since it is a structural formula that requires a lot of concentration, it is also not considered for the first time to prevent synthetic errors.

If the blood pressure returns and the circulatory dynamics stabilize, I don't have to do a blood transfusion... but when I estimate the amount of blood lost, it seems tough to do it without a blood transfusion.

"Dosage from 1L to 2L"

Continuing a large infusion at rapid dosing involves the risk of developing hypothermia, metabolic acidosis, etc., and since cardiac arrest can be seen if circulatory dynamics and blood pressure further stabilize, the determination of the transfusion must be made and initiated before the dose reaches 3 L.

Praying that his blood pressure would recover, he took preparations to transfuse Ellen's self-blood, and Pharma realized it was ruinous.

"Wait... why is there a theocracy team?"

The reservoir and freezer in the dispensing room that was stocking self-blood, the divine formation of the water attribute theology that was responsible for its cooling, were broken. Was it broken or has it been broken for a long time by fighting evil spirits within the pharmacy? I can't tell that. However, all pharmacy staff, except Pharma, probably had their own blood stocked inside the freezer, which turned to room temperature.

"Since when has it been at room temperature...?

Maybe it got to room temperature within a few hours, in which case it can be used, but I can't tell when it got to room temperature, so I can use this self blood.

I think so. I will look at the transfusion bottle, but the red blood cells are hemolytic and some of them are clotted, so it seems unusable.

(Can't you... have a blood transfusion?)

Perhaps I should go back to Imperial Pharmaceutical School and bring a human being who can transfuse, but considering the round-trip time, the life-saving rate drops desperately.

It's foolish to move her out of here bleeding out of it.

(Tell me, Ellen, how can I help you...)

wrap her hands around it.

As I ran in my brain every way I could deal with it, staring at her face in a prayerful way, I could hear the phantom.

"Farma, you look painful"

(Ellen... I'm just about to lose you right now)

"You're drowning and you can't breathe, and you seem to be frozen."

Exactly, but this word sounds familiar. That was when Emmerich Bauer and his family were working to improve the technology of genome editing as a pre-treatment stage for lethal familial insomnia that was causing him to get irritated. Ellen was left alone with a small voice in Pharma, who fell asleep in a less laboratory of fatigue and stayed put until morning.

I remembered the words I heard in the midst of all the discontinuities, and now I am connected.

"You have the power of a drug god, and you keep helping someone with your whole body and spirit instead of yourself... Because of the great power you can have, what you try to give is also huge and painful. Try to help everyone in that eye."

(I'm not such a fine person, I'm just scared. I can't wait to be scared of losing my loved ones and family in front of me to a disease I can help. Not to mention I was wondering if the tomb guard would come up with a shake back...)

"I wish I could help you someday, like you always do"

(Ellen, I needed you. I was always supported and helped by you)

Farma was in trouble.

Even with the power of the medicine god, what will it be? I don't have the power to save Ellen right now.

If this circumstance that shapes her fate was retaliation or rubbing against the intended pharma of the tomb guard, I don't feel helpful in any way.

(No medicine or divinity can heal you now... only a man's blood can bribe a man)

Could the tomb guard have craftily created this situation? And is Pharma going to take away the people who are on edge in this world? Squeezing his strength, Pharma stifles, rebelling without force.

I don't have any medicine, but I realize there seems to be some kind of divinity that I can use.

”Rescue of the Origin."

Envelop her with the unique secret of a drug scepter that can only be used by him. The light of divinity dropped the medicine divine mark on Ellen's body surface and was sucked into her body.

Even if all the phenomena in this world are in the hands of the tomb guards, they may buy some time with this divine art, as they did during the Black Death.

Finishing his stingy, Pharma drops a fuzzy glance in his own hands.

"Not yet. I still had something to use."

Instead of getting serious this time, there was something left that could be used physically.

(If it's my blood type... the blood type is different but I can)

Homogeneous transfusions are fundamental, but it is also possible to perform heterotypically compatible transfusions.

Fortunately, Pharma's blood type corresponds to type O where Earth is, and Ellen's blood corresponds to type A. I didn't put my own blood supply in perspective because of my lack of trust in Pharma's own blood, which has numerous cheat abilities and is not even an entity, but speaking of which, it was fit.

Pharma's type O red blood cells do not have blood type antigens, so they can supply blood to patients of all blood types. However, there is also agglutinin in type O plasma, which can cause side effects and be dangerous if massively transfused. But unless it's a massive dose, agglutinin isn't as problematic as being diluted with Ellen's blood.

I just want to transfuse only red blood cells safer, but I don't even seem to have time to be separating them.

"My blood isn't the best, but it doesn't fit."

There has been hesitation, but an urgent evacuation response is required. It's an emergency for her now.

Pharma switches her mind to transfuse her blood to Ellen, and proceeds with the procedure as she performs her own blood collection. However, anything that is not a drug, like blood, through the diagnostic eye, whether it is suitable for her body or not. I couldn't tell if there were any side effects until I tried transfusion.

"Leave your luck to heaven, but do you want a cross match"

Still, I would like to use my time while I am heavily dosing Lingel Acetate to see if an immune reaction occurs between Pharma and Ellen's blood.

Pharma had done detailed tests on autologous blood, but there were limited tests that could be done. When this happens, it's best to react directly to the blood problem. If you even skip that test and put it in her body once, you might lose control of transfusion side effects in her body.

So a cross-match test was performed between the blood of the blood donor for transfusion and the blood of the blood recipient to see if the antigen antibody reaction would not occur (cross-match test). After centrifugation, it was found from the results of the examination that transfusions were likely to be possible, while roughly estimating hematocrit values.

Pharma connects the tube to the inlet of the bottle of blood taken from herself and causes the non-woven filter for leukocyte removal to bite to remove the leukocytes. Still, the white blood cells stay, so I guess we should radiate and remove the white blood cells, like the original procedure, but I discount them because I don't have the equipment.

The route of Lingel acetate was charged with saline once and a transfusion was initiated.

"Go. All I can give you right now is my blood."

Pharma is still a minor and not old enough to be able to donate blood in the first place. I picked as many as 700 ml where I should only have donated 400 ml if I ignored my age and from my weight, but if I hadn't done a haemostasis while I was running out of this, Ellen would have no life.

"In the meantime, we need to hurry to stop the bleeding."

Pharma took to search the blood vessels responsible for the bleeding.

Using the diagnostic eye, I can discover where the bleeding is. Farma didn't work so hard to find the damaged area. But I can't even see what blood vessel the bleeding site corresponds to.

"Found..."

Taking matters seriously, Farma puts her hand around Ellen's back and clutches her hand from her wound thoughtfully. The complete loss of consciousness and the inability to separate the management of anesthesia by herself results in treatment without anesthesia.

Pharma's hands can then transmit the human body only when bare hands, thus making the most of its properties.

The phenomenon of transmission is always dreamy and reminds me that I myself am a foreign object to this world.

(To stop the bleeding, you have to look for the upstream artery, or portal vein, that leads to the vein that is the responsible vessel. Because there's no way I can remember the vascular distribution and the corresponding dominance... it becomes a smudge)

Pharma's fingertips can't pinch because she slips through all of Ellen's blood vessels when she's in a bare hand condition. In order to touch the blood vessels, you have to let Pharma's fingertips bite something. He creates a thin metal membrane, here titanium, through which blood vessels are pinched like clamps. After confirming the blood flow, return the substance to its original state.

First, I blocked the portal vein that commands the majority of the blood flow, but the bleeding doesn't subside.

Next, apply the thick blood vessel to the thin blood vessel and carefully check.

70% of the blood flowing into the liver is portal blood to carry nourishment to the liver and 30% is arterial blood to carry oxygen. It merges in the liver through a capillary called the sinus, into a vein. When there was no response due to portal vein blockade, the difficulty of finding blood vessels for the control of bleeding increased.

"It's this artery, I found it."

We found arteries with reduced bleeding from the picked mumps and hepatic veins. It is convenient for Pharma because it was not a portal artery but a hepatic artery that could be approached for treatment from the aorta.

You can clip with titanium as you go, but you can't clip well and leak blood because you can't do the plastic surgery well even if you can create matter.

(Make sure this is an arterial embolization procedure)

Instead of clipping and blocking from outside the blood vessels, we decided to opt for arterial embolization (TAE), which would clog the blood vessels and stop the bleeding. Pharma estimated the vessel diameter at the site where it was to be embolized.

Next, the thickest blood vessel in a person's body, two to three cm in diameter, penetrates the aorta, making a ring with his thumb and index finger, and sticks his fingertips in.

Feeling Ellen's blood flow, she creates ice pieces so that they are sandwiched between her thumb and index finger, and before they can be solved, she creates an embolic substance by putting it on the base of the ice pieces. I almost wanted to use spongy gelatin for embolic substances, but gelatin could not be created for Pharma because it is not a simple substance.

n-Butyl-2-cyanoacrylate (NBCA) is used as an alternative. This is not recommended for intravascular use in Japan.

(Don't flush this, if you flush it, it's tough)

If you fly this embolic material in the blood vessels, it will occlude the other blood vessels. But flying into the lungs is lethal. In the case of Pharma, even if it is flown, it can be tracked with the eye and removed with substance elimination, but great care is taken not to increase the amount of extra work.

The NBCA used as an embolic substance is used as an instantaneous adhesive, which, as its name suggests, polymerizes instantaneously when touched with trace amounts of moisture.

As he pinched the grains of embolic material that had finished polymerization and waited for the ice that had formed the foundation to dissolve, he passed through the vessels and led them from the aorta to the hepatic artery, carrying them to the thin blood vessels he had just stared at, eventually embolizing them. The NBCA created by Pharma has been made a little bigger than he estimated, but the diameter is not so important, you just have to embolize the vessel of interest anyway.

"That's good. Now we can block it!

The blood flow in the vein stopped after the loss, and most of the bleeding appeared to have subsided. Blood pressure recovers to about 90 mmHg. There were no signs of hypothermia due to thermal insulation, and the oxygen saturation is unknown, but the heartbeat is stabilizing.

Stuff the gauze from the back wound to suck away the stored light blood and take the gauze out of the wound. Organ damage other than the bleeding site of the liver was also searched, but no damage was sustained to the lungs, kidneys, gallbladder or bile ducts, major nerves, etc.

(Is this okay?)

I just ran out of blood transfusions. When I applied my eyes to the wasting, the light reaction stayed in the wound, and my entire body, which was reddened, was beginning to turn to purple. I know it means that I've lost my life, but Pharma won't let go. After cleaning the wound, the area within reach is sutured and gauze is applied to confirm that the bile is not leaking.

We have to put Drain away.

Drainage (drainage) is performed to drain blood, leachate, etc. stored in Ellen's body out of the body. After the open surgery, I insert a drain from my abdomen, but this time I have a puncture wound on my back. I was not sure if I would get a new drain into my abdomen but hesitated to make a new hole.

"I think I'll use this thorn wound."

I guess not in normal surgery, but since the wound edge, which is the periphery of the stinging wound from the back side, seems linear and free from frustration (mesh) or necrosis, I decided to use the stinging wound as a hole to drain out. When drained out on the back side, the tube crumbles when lying on your back, so that a tube with an inner strand can be turned into an open drain to drain even if crumbled, and the tip of the drain is covered with a sterile gauze.

When I looked at her through her eyes, the light that was wrapping her whole body was diminishing and she was turning to recovery.

After that, the coagulation system is monitored and the acid base equilibrium is corrected with the presence or absence of transfusion side effects. And although it was an anesthetic-free procedure, I finally came here to flush pentadine with an infusion for analgesia, adding glucose little by little in substance creation into the aorta to prevent hypoglycemia. By taking off the emergency, little by little, I've been able to manage calmly.

Pharma hugged her to wear it.

I don't want to leave her side, even when she does.

"Ellen, I want to see you. I want to hear your voice. For the first time in my life, I realized the size of your existence. You're a little too late... sorry."

I wanted to be her patron saint now, not the medicine god or something.

I have yet to tell her everything she was saving, everything I was receiving from her, and all the emotions that I felt toward her in this short and extreme time.

"I like it, Ellen. I loved you."

Inside the pharmacy of the two of us, the monologues around Pharma's tears echo.

- I didn't hear back.

But...... a familiar pattern appeared on Ellen's wrist. That looked like a thin pill godprint on Pharma's upper arm. Is Pharma's blood running through Ellen's entire body and acting in any way? Is it the manifestation of the drug divine mark as a sign of the mixing of the two blood? The doubt came back with a warm reaction as he arose and stood endlessly, so much so that he lost it and faintly shook Pharma's hand back.

(He's back...)

Pharma once again grabbed her, raw proof, with both hands.