The Enhanced Doctor

Chapter 1086: Chapter 1086: Indications Confirmed

(Thanks for the monthly ticket encouragement, Little Haohao)

"Teacher Liu, that patient experienced another episode of ventricular fibrillation. It’s been less than half an hour since the last time, and this is the fourth ventricular fibrillation since arriving at the hospital, in just over three hours."

Su Wenhao came to report.

"What about the results of the nasal examination?" Liu Banxia asked.

"No abnormalities were found, only capillary damage was observed," Su Wenhao said.

"What about the latest blood test results?" Liu Banxia continued to ask.

"Same as the first time, aside from some anemia, no other abnormal indicators were found," Su Wenhao quickly said.

"Damn it, write down the latest information and provide it for everyone’s reference." Liu Banxia said.

"Old Chen, Old Meng, what do you think? My personal opinion, anyway, is that the patient’s nosebleed does not seem like another symptom."

"However, in terms of related symptoms, we still have no clues. We did another echocardiogram, and the coronary arteries are fine."

Chen Xuehai also frowned, "I thought after determining the situation in the nasal cavity, our situation would become clearer."

"A nosebleed is simply one of those situations, right? Nasal lesions or damage, then there are systemic causes. Hemorrhagic diseases or blood diseases, acute febrile infections, cardiovascular system diseases, liver synthesis of coagulation factors disorders."

"But the patient’s blood test results are very clean, just anemic. The echocardiogram looks like the cardiovascular system is fine, why is this condition so annoying."

"But I still agree with Old Liu’s view that whether the nosebleed is an isolated condition or a symptom related to his frequent ventricular fibrillation, it should catch our full attention."

Meng Qingfan also nodded, "That’s indeed the case, his nasal mucosa looks quite normal. Then the frequent nosebleeds, could they be due to the blood vessels themselves?"

"Actually, I want to conduct a more detailed examination on him, but I’m also worried about potential dangers during the investigation. More crucially, his parents are not here yet, although we can get authorization over the phone, it still lacks a layer of meaning."

"Another issue is that the patient’s vital signs are not very good right now. He is currently hovering just above the passing line, and if several more ventricular fibrillations occur, I’m afraid his vital signs might collapse, and his heart won’t be able to take it either."

"We have also considered whether the cause of the bleeding is hereditary hemorrhagic capillary telangiectasia, but examinations of easily bleeding areas like the nasal and oral cavities showed no anomalies."

"Moreover, his nosebleed symptoms are somewhat related to pressure and fatigue, which makes them quite special. Director Liu, do the kids have any good suggestions?"

Liu Banxia shook his head with a wry smile, "Maybe they’ve been scared by the three of us. Although they’re studying it, no one dares to tell me yet."

"Liu Yiqing, come over. I just noticed you looking at us, what exactly do you want to say? Don’t have any concerns, just speak up."

"Teacher Liu, could it be an arteriovenous malformation?" Liu Yiqing tentatively said.

"If there’s arteriovenous malformation, sometimes it’s easy to have nosebleeds. But it seems it’s not easy to relate this to his ventricular fibrillation symptoms, I’m just talking nonsense."

Seeing her opinion being seriously considered by the three, Liu Yiqing felt somewhat panicked.

Actually, her thoughts were the same as everyone else’s. They all knew that time was tight, and they didn’t want to waste time because of random speculations.

The patient’s condition is rather critical, or else we wouldn’t gather here with only limited reception staff left outside to study this.

"What do you guys think? I think Liu Yiqing’s opinion is somewhat plausible." Meng Qingfan said after considering.

"It’s indeed feasible, but to examine arteriovenous malformations, we can only do an enhanced CT. It’s an invasive examination, and if ventricular fibrillation occurs suddenly during anesthesia, it would become very dangerous." Liu Banxia said.

"And even if we have tendencies right now, which region’s enhanced CT do we do? Is it chest and abdomen combined? It’ll take quite some time."

"Actually, the best method is to do a PET-CT, but the cost is too high. If the nosebleed symptom is a related symptom, it’s okay. If not, we can’t justify it to the patient’s family."

Liu Banxia’s words plunged the conference room into silence again, because this consideration is also necessary.

Currently, there is no approximate location for the lesion, so head regions can be ruled out. Because if there were arteriovenous malformations in the head, surely there would be other symptoms manifesting.

"Then we can only observe for a little bit longer, right?" Chen Xuehai said.

"If it happens two or three more times, regardless of the risk, we’ll have to conduct detailed examinations. Just two directions, one being the heart itself, we need to examine each fiber of the cardiac muscle."

"The other one is the arteriovenous malformation just proposed by Liu Yiqing, primarily targeting the vessels around the heart in the thoracic cavity. If no findings, then explore into the abdominal cavity, theoretically elevated venous pressure is also a main reason for nosebleeds."

"Meanwhile, we also need to closely monitor the patient’s physical condition, every twenty minutes... let’s do every fifteen minutes, conduct a cardiopulmonary auscultation. Each time the auscultation is conducted by two people to compare results, to avoid any errors."

"Alright, let’s leave it at that for now." Meng Qingfan nodded.

The current situation is somewhat special. It’s not that we can’t conduct the examination, but these are invasive tests, and given the patient’s condition, the risks are considerably high.

Chen Xuehai’s arrangements were thorough enough, enabling closer monitoring of the patient’s condition. We can’t rely solely on the electrocardiogram monitor.

"Teacher Liu, I hope I didn’t mislead you?" Liu Yiqing inquired.

"No, actually, I had considered that too, but the indications aren’t very clear at the moment." Liu Banxia replied.

"In the future, be bolder. If you have an idea, speak up. We don’t have to immediately verify it; at least the group can discuss it."

Liu Yiqing nodded.

"Brother Liu, why do I feel so tense right now? What is the PET-CT you just mentioned? Is it even more advanced than the MRI?" Qiu Mingyuan curiously asked, leaning in.

"It’s more like a one-time full-body scan. It can capture everything, and it’s quick." Liu Banxia explained.

"There are many advantages. It can detect tumors in their early stages before anatomical changes occur, aligning with modern values, though it’s somewhat costly."

"A full-body check-up costs about ten thousand yuan, sometimes six or seven thousand, which equals the cost of many MRIs and CT scans. But in the future, when Comrade Qiu comes for a check-up, you can schedule this."

"My goodness, this thing definitely burns money." Qiu Mingyuan remarked with awe.

At least they were part of the healthcare system and understood some of the situations.

Now they truly understood why they weren’t conducting it—it would be a few thousand down the drain if performed. It’s fine if it detects a problem, but what if it doesn’t? It wouldn’t be so pretty then.

For families like theirs, a ten thousand yuan check-up isn’t a big deal as long as it’s effective and painless. Even more expense wouldn’t be an issue.

But what about ordinary families? That’s real money. How much can you earn in a month?

"Even though it’s so expensive, appointments are needed daily. Our hospital has only one machine, so it’s not something you can get done just because you want to." Liu Banxia added.

"That’s why even if some of our patients can afford it, they seldom opt for it. The primary value is in early detection. If there are symptoms you suspect, targeted examinations suffice. When are you heading back to school?"

"Let’s wait a bit. Without concrete news from Xue Gang, I’m uneasy." Qiu Mingyuan said.

"Even though we didn’t know each other before, he’s still a student from our school. The situation is complicated now; I really hope you can pinpoint the issue quickly."

"Who doesn’t think that way? Everyone here is of the same mind." Liu Banxia nodded.

The intentions were good, but events often didn’t unfold as hoped.

After more than forty minutes, the patient had another episode of ventricular fibrillation, the fifth since admission. With this occurrence, everyone became more anxious.

But everything that needed discussing had been discussed. Meng Qingfan even called the director of the cardiology department for a consultation. The conclusion was the same: unless interventional exploration was done, medication alone would no longer suffice.

Liu Banxia and the others exchanged glances and managed a wry smile.

They truly hadn’t anticipated that a patient who seemed fine upon admission had become the most challenging case in the emergency center. Even though the patient hadn’t been moved to the ICU, the care in the hall was just as intensive.

"Teacher Liu, during the auscultation just now, I noticed the patient’s breathing sound on the right lung wasn’t great, and they were having some difficulty breathing," Su Wenhao hurried over.

"Is that so? Quickly, push the patient to the resuscitation room for a chest X-ray." Liu Banxia shouted loudly.

The long wait hadn’t been in vain; the patient finally displayed a new symptom.

This is the significance of observation. When existing symptoms are insufficient for diagnosis, observation is necessary until new symptoms emerge.

No matter what’s happening with the patient’s right lung, it was seen as a good sign.

Su Wenhao rushed back, helping to wheel the patient to the resuscitation room, with Liu Banxia and the others following behind.

It drew curious gazes from several patients undergoing trauma treatment; they thought something major was happening.

"Teacher Liu, the base of the right lung is white."

After taking the X-ray, although knowing Liu Banxia and the others could see, Su Wenhao still shouted.

Liu Banxia and the others exchanged a glance and smiled; their thoughts were unanimous: "The indication is clear."