Practicing Medical Skills in a Small Clinic

Chapter 574: Chapter 262: Eliminating Possibilities, Diagnosis from a New Perspective (2)

Getting caught up in a dead end is the easiest thing to happen when diagnosing complex cases.

After all, every doctor naturally feels confident in their own diagnosis and knowledge.

Even if this confidence may be misplaced, they tend to self-recommend and find it hard to extricate themselves.

Doctors running their own clinics are different.

Especially when they are both the boss and the doctor, striving to their utmost when diagnosing various cases.

They go to great lengths to identify the cause of the illness.

Because determining the cause can prevent accidents and also result in hefty treatment fees. If it’s a complex case, it can enhance the clinic’s reputation and prestige.

With so many incentives, clinic owners work hard to improve their diagnosis efficiency for all kinds of diseases.

"The patient initially presented with headache, sore throat, and fever, symptoms very similar to influenza. Could this be a viral infection?"

Li Jingsheng decided to look into the patient’s symptoms.

He carefully examined and enlarged the patient’s skin photos to see the details.

The backs of the hands and legs were covered with purple bruises of varying sizes.

Previously, he focused on the larger bruises; now, changing his approach, he was inspecting the smaller bruises.

"This may not be subcutaneous bleeding, but rather disseminated intravascular coagulation."

At that moment, his experience in cardiovascular disease diagnosis came in handy.

"If it really is disseminated intravascular coagulation, it must be acute."

His line of thinking was continually breaking new ground.

The day after the patient took medication, purple purpura began appearing subcutaneously on the face and limbs, varying in size.

This indicated the onset was very acute.

"Sudden purpura, acute disseminated intravascular coagulation, upper respiratory tract infection, sore throat with congestion, pre-onset use of antibiotics and antipyretics, headache, fever, mild tenderness around the navel, mild thrombocytopenia, significant increase in white blood cells and neutrophils..."

He combined all the information with the initial diagnosis results and began searching for diseases that matched these symptoms.

This method was indeed very practical.

It’s similar to a computer’s intelligent search: the more comprehensive the information provided, the more accurate the results.

"Sepsis caused by meningitis seems to have quite a few similar symptoms."

The most familiar is meningococcal septicemia.

Li Jingsheng’s eyes gradually brightened.

"Additionally, the patient has mild tenderness around the navel, joint and muscle aches, symptoms very consistent with allergic purpura."

However, based on his medical knowledge and clinical experience, such widespread mucocutaneous bleeding typically results in very low platelet counts, usually not exceeding 50 × 10⁹/L.

In most cases of widespread bleeding, platelet counts are below 30.

"Should I get a chest X-ray?"

If possible, an ECG could also be checked.

But each additional test deducted one or two points, making him very cautious.

He still suspected that viral meningitis was more likely.

If that’s the case, getting an ECG and chest X-ray would be a waste.

Better to do a blood gas analysis.

Despite its fancy name, it’s actually just a routine test.

Blood gas analysis involves drawing a portion of arterial blood to check certain indicators.

Including partial pressures of oxygen, carbon dioxide, lactate, and other indexes.

It is mainly used to evaluate the status of microcirculatory metabolic function in the body.

Upon requesting this test, another point was deducted.

Two points have now been deducted.

So far, a complete blood count and a blood gas analysis have been conducted.

The blood gas analysis results came out quickly.

This indicates the examination was performed during the patient’s treatment process.

He was secretly pleased, as the path seemed correct.

It appears that the past year spent working at the clinic was not in vain.

Of course, the major gains came mainly during the more than three months after obtaining the attribute panel.

One cannot cook without rice; if not for the increasing number of patients over these months, providing ample practice opportunities, his improvement would not have been as rapid.

Blood gas analysis results: metabolic acidosis with decompensation, carbon dioxide partial pressure 27.6 mmHg, oxygen partial pressure 132.7 mmHg, serum potassium 2.7 mmol/L, sodium and chloride within normal ranges.

Blood urea nitrogen 29.9 mg/dL, hemoglobin 163 g/L, white blood cells 18 × 10⁹/L.

Neutrophil percentage 89%.

Platelets 43 × 10⁹/L.

Upon seeing this result, Li Jingsheng’s mouth twitched.

It’s simply a bug.

The patient’s initial platelet count at admission was around 80, and now it’s 43.

This indicates the results were obtained after the patient received treatment following admission.

In this short period, the patient’s platelets nearly halved.

Did the treatment cause issues?

Or was there a significant change in the patient’s condition?

Li Jingsheng grinned sneakily to himself, pondering.

He looked up again to view the venue and noticed someone else displaying a similar sneaky grin.

It seemed these doctors also thought of requesting the blood gas test.

He needed to act quickly, otherwise, it would be too regrettable if someone else got ahead.

He was confident that, so far, doctors similar to him, who had only used two routine test opportunities, must be rare.

There might be big names in the field of hematology, whose extensive clinical experience meant they used even fewer test opportunities than he did.

True experts in their field can be exceedingly exceptional.