Free Web NovelChapter 1112: Chapter 1112: Difficult and Complicated Cases?
(Thanks to Lang’s Sky W for the monthly ticket encouragement)
"Let’s discuss this again before dinner. I always feel that the current situation is a bit troublesome." Liu Banxia said.
"Whatever you fear might happen, might indeed happen. But at least we can currently confirm it’s respiratory bleeding. The key symptoms are still the lung condition and anemia, and then there’s coughing up blood, right?" Xu Hui said.
Liu Banxia nodded, "We have already done a bronchial exam and taken samples for culture. The results should come out tomorrow."
"But from the situation with the bronchial exam, other illnesses are unlikely, at most it’s just lung inflammation. You can’t just perform a bone marrow puncture because the anemia isn’t very serious, right?"
"My personal opinion is still to observe first. Currently, some antibiotics and hemostatic drugs can be given. See if there are any other related symptoms. As of now, things seem clouded, and still nothing can be discerned."
"Brother Xu, how significant do you think the relationship between coughing up blood and anemia is? From the patient’s blood loss, can it cause anemia?" Liu Banxia asked.
Xu Hui shook his head decisively, "That amount of coughing up blood hardly affects anything, which is why this patient is particularly difficult to diagnose."
"It seems that the lung inflammation isn’t very severe, so we can’t determine if her coughing up blood is caused by pneumonia. And this multitude of negative tests really increase the difficulty of our diagnosis."
Coughing up blood, pneumonia, anemia, these are the three major symptoms currently. These symptoms seem to be related, but clear indicators can’t be found.
Pneumonia can cause coughing up blood, but it has to be quite severe pneumonia. Coughing up blood can lead to anemia, but that requires quite severe blood loss.
Currently, the patient’s symptoms are mild, which puts us in a dead end for the next examination direction.
"Teacher Liu, do you think the patient’s fatigue symptoms could also be related to their illness?" Xu Yino asked at this time.
Liu Banxia thought for a moment and nodded, "Mark this too, the patient’s condition is really too complex right now. It could be fatigue caused by pneumonia and coughing up blood, or fatigue caused by the illness itself."
"These symptoms can be interrelated, or they can be independent, they’re just coincidentally together. Brother Xu, do you have any more guiding opinions?"
Xu Hui shook his head, "Didn’t I just say it? For now, we can only treat symptomatically and see if our medication shows any improvement in the patient’s symptoms."
"The advantage here is that it can relieve the patient’s current pain, and also help us further determine whether there are links between these symptoms."
Liu Banxia nodded, "Then let’s proceed like this, start medication and observe. Pay more attention tonight; the first-time medication effect should be more noticeable."
"Okay, Teacher Xu, should I still take charge of the patient?" Xu Yino asked tentatively.
"You all learned this bad habit from Teacher Liu, always asking me. You take charge, but pay more attention to the patient’s indicators." Xu Hui said.
"Thank you, Teacher Xu."
Xu Yino said cheerfully and then dashed out.
Under normal circumstances, patients admitted to internal medicine should be managed by internal medicine staff. But given the current situation, the internal medicine team isn’t very full, so it’s okay for Xu Yino to manage temporarily.
"How about that, didn’t I train a good bunch?" Liu Banxia asked happily.
"They are indeed good, but a bit too cunning. All learned from you, they were such good kids before." Xu Hui reflected.
"This is called learning by doing, how about the two of us supervise this patient? Based on tomorrow’s situation, we can organize a slightly larger teaching consultation." Liu Banxia asked.
"Okay, but don’t be careless. This patient really is tricky, once we get back, we need to think about this thoroughly. If necessary, check endocrine, it might be an endocrine disorder causing the issue." Xu Hui said.
"However, it’s also a headache. If it were an endocrine disorder, it would usually show reactions in electrolytes, and for now, it doesn’t seem problematic."
"Anyway, first do a physical exam tomorrow morning, after that check the thyroid. Better safe than sorry, we always need to approach endocrinology with great caution."
"That’s right, the case with Tang, and today’s case of severe hypokalemia, both were related to thyroid." Liu Banxia said.
"Today’s patient’s situation is really worrying; despite having very low blood potassium, no external symptoms show besides muscle weakness."
"Only when we did an ECG did we realize the heart problem is very severe. But with such a low level, the danger surely didn’t develop in just a day or two."
"He had no issues until he was prepped at the hospital, then he experienced ventricular fibrillation. Otherwise, normal intravenous potassium supplementation should suffice, but now he must be sent to ICU."
"At the time, I discussed this issue with them. I felt it might be influenced by the hospital environment and hearing related news, which increased his stress and aggravated heart conditions."
"That is highly likely." Xu Hui nodded.
"It’s like some cancer patients who might not know their prognosis and end up living longer. Conversely, once diagnosed, some cancer patients start worrying too much and their condition progresses faster."
"However, these observations are just psychological guesses based on cases, and it’s hard to use data to back them up with precise evidence."
"By the way, our emergency center has a fecal transplant project and your NOSES surgery promotion here. Are there any policies or benefits associated with these initiatives?"
"There’s definitely none on my end. I think you guys should apply for something," Liu Banxia thought for a moment and said.
"You have more aspects to deal with over there. Here, we mostly focus on surgical procedures and post-operative data tracking. Though you have a lot more to figure out, and need to consider everything comprehensively, I believe success is just a matter of time."
"Currently, the number of patients served by our fecal transplant project is quite decent, and the success rate is over 60%, right?"
Xu Hui laughed, "Though the current percentage is high, using it as a selling point is difficult. We can only say that fecal transplant has some efficacy; the bacterial situation in the intestines is too complex."
"Alright, I need to leave work and head home. Keep an eye on that patient tonight, and I’ll come early tomorrow morning for a discussion with everyone."
"Okay then, I also need to go home to see my daughter and son," Liu Banxia said.
This all happened in just half a day, thought about longingly by him anyway.
This time the food didn’t wait for Zhou Qiang to deliver; Liu went directly to get it. There weren’t many people tonight, just their family members.
"Hey, Tang, how come you’re here?"
Just as he returned to the ward, he saw Tang Feifei there.
"Taking advantage of having little to do, I came over to check things out," Tang Feifei said with a smile.
"I wanted to come yesterday, but the flight got canceled, so I rescheduled for today. These two little ones are so well-behaved; I’ve been here for over two hours and they’ve been sleeping the whole time."
"Sigh... I’m hoping they’ll stir up a bit so I can hold them," Liu Banxia sighed.
"Who’s to blame? You had the chance, but you didn’t seize it," Qiaoqiao gave him a look.
"I messaged Xu Yino and Liu Yiqing, asking them to come for a meal. Tang bought so much stuff, I can’t possibly eat it all myself, need to share with them."
"By the way, Qing Kewa will be coming over in the next couple of days. That girl was so thrilled to see the little ones; she’s even more excited than I am. I wonder what she’s thinking, I’m worried she’ll try to steal our babies."
"She’s probably just too bored over there and jumped at the chance to fly over here," Liu Banxia said with a laugh.
"Tang, have you had your thyroid function checked recently? We admitted a patient today who is suffering from severe hypokalemia due to hyperthyroidism and is currently being treated in the ICU, still not out of danger."
"My goodness, it’s that serious? Feifei, you should come to my place for a blood test tomorrow," Qiaoqiao said with concern.
She knew Tang Feifei had thyroid issues, but never paid much attention to it. It was just a matter of a thicker neck and occasional bed-wetting, not much else.
Now hearing how it could lead to being admitted to the ICU, as a semi-professional herself, she naturally recognized that it was truly dangerous.
"Qiaoqiao, I get regular check-ups; I wouldn’t dare let it get to that stage," Tang Feifei said with a smile.
"I’ve managed it well so far, and the doctors there say the treatment was timely. Just need to maintain stable control, and there’s no worry about future problems or affecting normal life."
"So I’m really grateful to your family’s old Liu, whenever someone I know feels unwell, I’ll refer them to come for a check-up."
"Real medical issues can be checked, but don’t keep asking me for chiropractic work; I’m genuinely overwhelmed," Liu Banxia complained a bit.
At this moment, Xu Yino and Liu Yiqing walked in, and everyone gathered together happily to eat.
"Teacher Liu, what do you think about today’s patient situation? Is it a legitimate rare disease? What will be the focus of tomorrow’s examinations?" Xu Yino asked.
Liu Banxia laughed, "You’ve already said it’s a rare disease, so tomorrow we’ll have to go with how the situation evolves."
"Tell me about it; I’ve got nothing else to do," said Qiaoqiao, munching on a black chicken leg.
Although staying here is quite nice, it can get a bit boring.
Can’t keep staring at the babies all the time.
The two little ones were behaving very well today, making her feel like there wasn’t much to do.
