The Enhanced Doctor

(Thanks to Moonlight Breeze for encouraging with the monthly ticket)

Early the next morning, Liu Banxia arrived at the emergency center and went straight to the ward.

However, it wasn’t the ward of their second department, but the cardiothoracic surgery ward. Even after going home yesterday, he was still concerned about the condition of the patient with lung contusion.

After observing the patient’s vital signs for a while, although they weren’t up to standard, they were relatively stable, which was quite good.

After all, it would take two to three days for adjustment before absorption would start, and that’s when signs of improvement would appear.

I guess I was just overthinking it. Although there was a task accompanying this patient, it should just be a coincidental severe lung contusion.

After leaving here, he started his rounds in his own department.

The last room today was left for the person donating a liver to his father.

"How are you feeling today?" Liu Banxia asked with a smile.

"I feel much better. It was really uncomfortable in the ICU," the patient said with a smile.

"Doctor, can I get up and walk around today? Lying in bed, the longer I lay, the more tired I feel. Will a little exercise help?"

"It’ll be tomorrow. Just hold on for one more day, and then you can walk a little circle in the ward tomorrow. Your surgery was quite major; even if you love to exercise, you have to take it slow." Liu Banxia replied.

"Director Liu, is my brother alright? There won’t be any other complications, right?" the patient’s sister asked.

"The indicators are currently quite good, and your father is fine in the ICU too. However, considering his age and the impact of his previous liver cirrhosis on his body, he still needs to stay a couple more days," Liu Banxia said.

"There’s no need to rush, everything has to progress gradually. Keep a good mood and have confidence in life. It will have some impact on your body, but the impact won’t be significant."

"This was all carefully explained to you before the surgery, and now everything is developing as we expected. Moreover, both you and your father’s recovery is better than anticipated."

Hearing this, the siblings smiled. This was the news they most wanted to hear.

The entire process is a long-term recovery process; it’s not only important to be good now but also to be good in the future.

After seeing this patient, Liu Banxia finished his round and officially started a new day of work.

Just as he was about to go to the lobby, his phone rang.

"Old Chen, what’s up?" Liu Banxia asked with a smile after answering.

"Come to the cardiothoracic ward; the patient with the lung contusion yesterday developed symptoms of rhabdomyolysis." After saying this, Chen Xuehai hung up.

Liu Banxia was taken aback, then hurriedly ran to the staircase.

Taking the elevator requires waiting, running up the stairs is faster.

He hadn’t expected that less than an hour after he left, the patient’s condition would change.

"Old Chen, what’s the situation?" Liu Banxia asked after running to the ward.

"Swollen legs, blood in the urine bag. We’ve already drawn blood for biochemistry, diagnosed as rhabdomyolysis," Chen Xuehai said.

Liu Banxia also carefully examined and furrowed his brow deeply.

This patient indeed had more undetected symptoms, overshadowed by the lung contusion.

"Doctor, what exactly is going on? Wasn’t everything fine when you came by in the morning?" the patient’s family member asked.

"Please don’t worry; we are currently investigating the cause." Liu Banxia comforted them and continued observing the patient closely.

"Beep-beep... Beep-beep..."

At this moment, the patient’s monitor sounded again, indicating a seizure.

"Administer a shot of diazepam."

Liu Banxia promptly instructed.

The nearby nurse quickly gave the patient an injection, and the patient’s body gradually stabilized.

"What do you think could be causing it?" Chen Xuehai asked.

Liu Banxia shook his head, "Yesterday’s biochemical results didn’t show any abnormalities; let’s see the latest one. We thought it was severe lung contusion; turns out there’s another underlying issue."

"Should we call someone from neurology over? The recent seizure might be indicative of another condition; I’m concerned about persistent seizures."

Chen Xuehai nodded.

He felt somewhat helpless regarding this patient at the moment.

"Come over here; please tell me again if she’s had any abnormalities these days," Liu Banxia said to the patient’s family member.

"No, she’s been perfectly normal. Lately, she’s been working out; otherwise, she wouldn’t have thought of riding a shared bike," the family member replied.

Liu Banxia walked to the patient’s side and felt her body temperature with his hand, indicating no signs of fever.

If there is a postoperative infection, it might also trigger seizures.

But since there isn’t a high fever currently, the cause of infection can basically be ruled out.

"I felt something was wrong yesterday, but what’s actually causing it in the patient?" Liang Xiaolin said.

"We can’t rush this, let’s wait for the biochemical results to come out and take a look. Normally, it shouldn’t be like this. But it’s confusing that there’s also rhabdomyolysis." Liu Banxia also muttered.

Rhabdomyolysis is a common condition in the emergency center. It’s mostly due to excessive exercise or, like the patient we rescued last time wrapped in concrete, from crush injuries.

This patient was hit, but that was yesterday. If that were the cause, it should have shown soon after admission or last night.

Now she spent a night in the hospital, had her electrolytes replenished all night, but then developed rhabdomyolysis.

Auscultation of the lungs still aligns with severe pulmonary contusion.

From the physical examination results, there’s nothing that could draw their attention to the situation.

"What’s the patient’s condition?" At this moment, Peng Bo from the neurology department also rushed over.

Liang Xiaolin hurriedly gave a detailed introduction of the patient’s condition.

"Could she have hit her head when she fell?" Peng Bo asked.

Liang Xiaolin shook her head, "The patient doesn’t have any head contusions or lacerations, she was hit by an electric bike, and the impact was mainly on the chest and abdomen."

"That’s quite strange, a rheumatological or autoimmune disease? I’ve never seen such a peculiar presentation." Peng Bo said.

"If we look at it from the current situation, the patient should have been in the developmental stage of a condition before admission, but the injury accelerated it into an acute phase."

"The current symptoms are rhabdomyolysis and seizures, but what’s going on with the spleen? Director Liu, this is your domain."

"It also suffered an impact; the CT scan showed a hematoma, but the capsule wasn’t ruptured, and it’s not severe, so no surgery was done," Liu Banxia said.

"In that case, my suggestion is to first scan the head to see if there’s an organic lesion." Peng Bo said.

"Normally, if it was just an impact injury without head trauma, it usually wouldn’t cause seizures. Besides, yesterday’s admission records also showed hypotension and hypoxemia."

"Our general understanding is that this was caused by the impact on the patient. Is it possible that the patient’s original blood pressure and blood oxygen weren’t high either?"

"Could it also be possible that the spleen was slightly enlarged originally?" Liang Xiaolin added.

"That can be considered as an alternative option." Liu Banxia said.

"Currently, some of the patient’s symptoms might be masked by the pulmonary contusion. It’s also possible that certain conditions caused the severe pulmonary contusion in the patient, that’s also a possibility, right?"

Chen Xuehai nodded, "So that suggests that the patient’s current symptoms are also interacting with each other."

"Teacher Chen, the biochemical results."

At this moment, Liu Liang, the intern from the cardiothoracic department, ran in with the biochemical report.

After Chen Xuehai received it, he carefully examined it and then handed it to Liu Banxia.

Liu Banxia took a glance, furrowing his brows tightly.

The patient’s relevant indicators are all within normal range, such as blood glucose of 6.1, blood sodium of 136. The slightly abnormal ones are lactate at 8.3, potassium at 5.5, and pyruvate at 2.2.

"Is this lactic acidosis?" Liu Banxia asked.

"Let’s first administer sodium bicarbonate and glucose. The key is whether this lactic acidosis is primary or elevated due to rhabdomyolysis?" Chen Xuehai countered.

"Moreover, this elevated pyruvate, does it suggest a problem with her body’s current glucose metabolism? Because her blood glucose concentration is still normal,"

"That is possible, let’s correct it first and then study further," Liu Banxia said.

If the patient was diabetic, then all the problems would be easily resolved. However, the patient is not, and her blood glucose is quite normal.

The patient’s current symptoms can be designated as hyperlactatemia.

Lactate and pyruvate are actually intermediate products of glucose metabolism. It’s due to an issue in this process that caused the accumulation of these substances, triggering the symptoms.

In normal glucose breakdown, it follows the usual route when oxygen supply is sufficient. Although the patient’s current blood oxygen isn’t at normal levels, it’s just slightly low, normally it wouldn’t affect glucose breakdown.

"If the patient has such metabolic disorders, I think a head CT is necessary. Also, we should contact the internal medicine department as well, right?" Peng Bo said.

"Let’s call Wang Huan and see how the correction affects first," Liu Banxia suggested.

"However, yesterday when we checked, these values were normal. It seems they only began to elevate this morning?"

"So, we’re in the acute phase of the condition now, likely due to the impact of the injury," Peng Bo said.

"But the human metabolic system involves a wide range, and there are many places where issues can exist. It’s not easy to investigate, it has to be done step by step."

Everyone nodded, looking at the patient on the bed, feeling a slight sense of helplessness.

Dealing with symptoms that mask and influence each other is truly challenging to trace back to the source.