Free Web NovelChapter 575: Chapter 262: Eliminating Possibilities One by One, a New Approach to Diagnosis_3
Just by listening to the patient’s description of the illness, he could diagnose the cause.
He glanced at the blood gas analysis time; it was only a little over two hours from the patient’s initial diagnosis time after admission.
In such a short time, the patient probably hadn’t had time to complete the admission procedures.
When the hospital receives such a patient, it’s impossible that they would blindly admit them without any examination.
Otherwise, the hospital would have gone bankrupt long ago.
Not every family member is easy to deal with.
If someone dies, compensation is at least hundreds of thousands. Even in a larger hospital, if one or two patients die a day, the hospital would have worked for nothing.
Moreover, a high mortality rate will trigger various supervision and assessments.
This patient went to the hospital at around eight in the evening because of a lot of purpura on the skin, which made him scared.
What if he died in his sleep at night?
The patient himself might not be afraid, but his family would be.
They would undoubtedly urge him to go to the hospital overnight for a check-up.
At night, specialized clinics are closed, with only emergency services and sudden illness centers on duty 24/7.
Since the patient only had purpura on the skin, he couldn’t possibly run to register at the sudden illness center.
Even if he went there, they would not admit him.
Because this isn’t a chest pain or cardiovascular disease.
So, he could only register at the general emergency.
The emergency department has no authority to admit patients; they must call specialized doctors.
Analyzing it this way, Li Jingsheng estimated that the patient had been waiting, undergoing various tests for two hours since admission.
The emergency doctors on duty at night are often young and inexperienced.
How could they order fewer tests?
Seeing the patient’s body full of purpura, which young doctor wouldn’t be trembling?
They would certainly perform every necessary test!
Therefore, the patient likely didn’t receive any treatment during these two hours. For the condition to change so rapidly in just two hours, ordinary viral meningitis wouldn’t have this capability.
The only thing that came to Li Jingsheng’s mind was fulminant meningitis, and the acute kind.
The patient’s platelets suddenly halved, and he certainly couldn’t withstand it.
At this point, he was most likely in a state of shock.
He silently speculated about the patient’s condition at that time.
The examiners were cunning, intentionally withholding information about the progression of the illness. They let the competitors diagnose on their own and fill in the gaps with their imagination.
Experienced doctors have a significant advantage.
Li Jingsheng, for instance, realized as soon as he thought about the patient’s platelets dropping by half in two hours, which fell by nearly 40, that the patient was in shock at that time.
The hospital wouldn’t just watch a patient die and do nothing; the emergency doctors would certainly initiate resuscitation immediately.
The blood gas analysis showed metabolic acidosis in the patient.
But was this blood gas analysis’s result done before or after the patient went into shock?
It was most likely urgently redone after the shock.
If done after shock, the receiving doctor was likely panicking as the cause was unknown, then how should they proceed with resuscitation?
Although the patient had signs of respiratory infection before admission, who could be certain that pneumonia caused the shock?
The rescue measures at this time would undoubtedly lean to the conservative side.
Strengthening antibiotics and actively replenishing blood volume is standard procedure.
In a big hospital, the possibility of supplementing blood volume and infusing crystalloids and plasma for resuscitation is the highest for such patients.
They would also likely perform catheterization to keep urine output around 150 to 160 ml.
To optimize the resuscitation effect, vasopressors might also be used.
After using vasopressors, Li Jingsheng predicted that the patient’s purpura might worsen, with a high chance of small patches merging into larger ones.
This case was chosen as a test question, meaning the patient was eventually cured.
Otherwise, wouldn’t the receiving hospital and the attending doctor be embarrassed?
Besides, if the patient died, the test question’s answer would be full of uncertainties.
Many treatment measures would only be known to work after being tested on the patient, not just by making predictions based on experience.
After thinking it through, Li Jingsheng began to backtrack based on the results.
He ultimately still concluded that the possibility of fulminant meningitis was the greatest.
Primary immune thrombocytopenic purpura had some discrepancies, so he completely dismissed it.
Without further hesitation, he directly wrote in the answer column that, due to the patient’s sudden platelet drop about two hours after admission, shock might have occurred, indicating that the disease progressed rapidly and fiercely. Primary immune thrombocytopenic purpura was more inconsistent, and since the patient showed signs of respiratory infection, headache, and fever before admission, with blood gas analysis showing metabolic acidosis, I believe the possibility of virus infection leading to fulminant meningitis is the highest.
After writing, he gave the treatment measures.
He suggested anti-shock treatment followed by the use of 11 million units of high-dose penicillin intravenously, fluid and potassium supplementation, and correction of metabolic acidosis. Intubation and mechanical ventilation could be used for emergency rescue if necessary.
After finishing the answer, he submitted it.
He gently exhaled a breath of turbid air. Even though it was just answering a test question, it still made him feel as if he had personally been on the battlefield, engaging in a life-or-death rescue of a purpura patient.
Vice Dean Jin glanced at Li Jingsheng with some surprise.
Because so many doctors from the Second Hospital came, many just glanced at the tablet and quickly gave up.
Li Jingsheng was the only one who persisted until the end and wrote down the answer on the tablet.
"Newborn calves are not afraid of tigers! Regardless of whether the answer is correct, at least this active participation attitude is very good."
Dean Jin felt that, even if it was zero points, writing an answer was better than submitting a blank paper.
It seemed the first question was indeed a bit difficult since he quietly observed the entire venue, and over 95% of the more than three thousand participants hadn’t lasted over five minutes.
Time continued to pass bit by bit.
The host switched the large screen on stage, showing a countdown timer.
Tick-tock sounds of timing were also heard.
This was to remind the participants to hurry up and answer.
Since it was a competition with thousands of participants, it was impossible to have the participants answer questions without time limits.
"Okay, time’s up! Thank you to every doctor for your active participation. Now please see the system scoring and ranking."
As soon as the host finished speaking, the screen changed again.
"Scoring statistics in progress!"
These days, high technology is really beneficial.
If it were manual scoring, the judges would be exhausted. And getting results within a day would be considered high efficiency.
Over three thousand pairs of eyes were tightly fixed on the large screen.
Many people held their breath, watching nervously.
Especially those participants who successfully submitted their answers—they were all both nervous and expectant.
Who wouldn’t want to stand out in the first trial?
Everyone wanted to win glory.
Li Jingsheng, on the other hand, was calm because this wasn’t his area of expertise. Achieving a ranking and having a good start would naturally be gratifying.
Even if he didn’t make it to the rankings, this diagnosis still brought him significant progress.
