The Enhanced Doctor

"In the past, I often saw the term ’tetanus toxin’ in novels, where several toxins mixed together, treating one thing would make another worse. Although our patient hasn’t reached that level, handling it is still very tricky."

Liu Banxia said with a bitter smile.

"This unknown illness has a huge impact on the patient’s body. And her pulmonary contusion covers up some problems that should have been present very thoroughly."

"Even if we peeled off this layer of pulmonary contusion, we wouldn’t see the actual situation inside. And this layer is really difficult to peel off."

"Right now, the most urgent thing is to figure out her high lactic acid level. Personally, I lean towards the endocrine system as the cause." Peng Bo said.

"It is precisely because some illness is causing her high lactic acid level that she develops lactic acidosis when we try to adjust her electrolytes. Does Doctor Wang have any direction?"

"Investigating this is quite tricky, various possible causes could have an impact. The human endocrine system is also quite complicated and can only be ruled out bit by bit." Wang Huan said.

"Based on the current blood oxygen situation, at least we can rule out issues caused by oxygen supply problems. It’s only after acidosis sets in that blood oxygen and blood pressure continue to fall, but what about her seizures? Could it be caused by lactic acidosis?"

"That’s why the causality of this patient isn’t easy to unravel. Is the low blood pressure and enlarged spleen due to post-car accident impact, or were they existent, only covered up by the accident, it’s hard to sort out." Liu Banxia said with a bitter smile.

"There’s another situation, the patient’s coagulation time should be worse than when we checked before yesterday’s surgery."

"Look at the drainage tube in the chest cavity, the proportion of blood is still quite high. Normally, Doctor Liang has completed the hemostasis surgery, after a night, there should only be some seepage at most."

Upon hearing his words, everyone turned in sync to look at the drainage tube in the chest cavity.

Sure enough, there was blood in the drainage tube. It’s not really like a major hemorrhage patient; the coagulation test before surgery yesterday was normal, but now it seems somewhat abnormal.

No need to further test coagulation time, it’s definitely a problem.

"Currently, our plan is to first administer sodium bicarbonate and glucose, what’s next? Check or observe first?" Chen Xuehai asked.

Upon hearing his question, everyone looked towards Liu Banxia.

If we go for a check, it’s too extensive. Especially checks on the endocrine system, doing a full set could keep us busy for a whole day.

"Why are you all looking at me? I’m also a bit puzzled now." Liu Banxia said with a bitter smile.

"Make a decision, we mostly focus only on our own domain, you usually deal with various departments more." Wang Huan said.

"If pressed for a recommendation, I think we should first observe." Liu Banxia said.

"Firstly, the patient’s blood pressure isn’t very high right now, we are also slowly administering blood replenishment. Further checks would require drawing several tubes of blood, which could impact the accuracy of the tests."

"Secondly, there’s the patient’s coagulation time. The spleen still has tears, check-ups involving back-and-forth might rupture the capsule, then we’d have to operate again."

"So my opinion is to observe, at least until noon. If our sodium bicarbonate and glucose supplementation can improve the patient’s condition, it will save us a lot of trouble."

"The cause can be explored gradually, the key is still the patient’s health. The pulmonary contusion affects the patient significantly, so prioritizing stability is better."

"Alright, we will do so, pay extra attention to this patient’s condition." Chen Xuehai nodded.

The temporary consultation came to a close. Although the true cause of the patient’s illness isn’t yet clear, there’s more or less a direction and method for coping.

This method seems a bit opportunistic, but currently the patient’s vital signs are relatively stable, and sodium bicarbonate and glucose have been given. We can first observe the effect.

"Teacher Liu, what’s the situation with that patient?"

After Liu Banxia returned to the lobby, Liu Yiqing asked curiously.

"Can’t determine now. Let’s observe first, then decide on further checks." Liu Banxia said.

"Have you been playing games with the patient who has phantom pain? You need to persist, playing once a day might eventually be effective."

"In the afternoon, there are more patients in the morning." Liu Yiqing said.

"Teacher Liu, are you busy now?" Miao Rui asked.

"What’s the patient’s situation?" Liu Banxia asked.

"Just brought in the patient; according to the paramedic’s description, before fainting, the patient appeared to be in a drunken state, walking unsteady. After falling, hit his head, there’s a laceration." Miao Rui said.

"During diagnosis, we found the patient was confused, and appeared to be in a state of intoxication. However, there was no smell of alcohol, and the patient’s blood pressure was a bit low. They’re being sent for a head CT now."

"Then we’ll have to wait for the results. It could be a primary lesion in the head. What is making you perplexed?" Liu Banxia asked.

"It’s just the patient’s presentation. If there’s a brain tumor pressing on the nerves, the patient would indeed show behavioral changes, but it doesn’t usually look like intoxication." Miao Rui said.

"Teacher Liu, do you think this patient might also be using drugs? By the way, he’s only twenty-seven. He was found fallen by his car and brought to the hospital by a concerned citizen’s call."

"You want to do a toxicology test, huh? But we don’t have enough to support that now." Liu Banxia said with a smile.

"Testing naturally incurs costs. With the current condition, there’s still no way to judge. But you can first do some surface examination to see if there are any puncture marks."

"If it’s just drug use, there’s nothing we can do unless the patient develops hallucination symptoms; only then can we lean in that direction. Are there any now?"

Miao Rui shook his head, "No, it just looks like he’s intoxicated. His speech is somewhat disjointed, but still coherent in sentences."

"Having this kind of inclination judgment is good, but we can have a certain judgment inclination, yet examinations for the patient should still be based on indications." Liu Banxia said.

"It’s not like abroad here; if we were abroad, that stuff is rampant enough to become a preferred admission check."

"Okay, I understand." Miao Rui nodded with a smile.

Actually, he almost ordered a toxicology test just now, but he restrained himself. The thought at the time was direct, but in hindsight, it was indeed a bit risky.

If the patient had another ailment and found a toxicology test on the bill upon discharge, they might get upset.

Being a doctor isn’t easy; ordering tests isn’t so straightforward either.

This can also be seen as helping Miao Rui handle some minor issues in admissions, even though he often spoke of them before.

But during admissions, many issues manifest in various forms and require serious analysis.

Liu Banxia kept pondering over that patient with the lung contusion. Observation is conservative treatment. But such a decision doesn’t mean ignoring the patient.

We also need to anticipate or further analyze the patient’s situation. Seeing that Liu Yiqing and Li Hao didn’t have any tasks, he wrote down the basic symptoms of the patient for them to discuss with the interns.

"It’s really difficult, just looking at these symptoms, without testing, it’s likely nothing can be concluded, right?"

After some discussion, Liu Yiqing asked.

"That’s why we’re having you discuss it. Does anyone have any bold ideas? Think about it in your spare time at work." Liu Banxia said.

"Observe until noon, then in the afternoon, we’ll have to do some instrumental tests. It’s also quite tricky, we must do as few as possible but can’t be reckless."

"It’s hard to figure out. It started as a car accident injury, then a lung contusion, followed by rhabdomyolysis, lactic acidosis, clotting disorder – who knows what the initial problem was." Liu Yiqing said.

"Maybe it’s just a severe lung contusion which led to a series of physiological failures. Now it looks like the whole body has issues. As long as the splenic hematoma doesn’t rupture due to clotting disorder, that’s a success."

"Dr. Liu is absolutely right. That’s why we haven’t stressed the patient with tests, opting to observe first." Liu Banxia gave a thumbs-up.

"Oh, Teacher Liu, be serious, we’re discussing the patient’s condition." Liu Yiqing said helplessly.

"Think about it when you have time. I guess Director Chen is also discussing it. After all, the patient was admitted to their department and Liang Xiaolin was the surgeon."

"Heh, I’ll go and ask Linlin for some news later." Liu Yiqing said gleefully.

"Goodness, without Xu Yino here, you’ve become the informer." Liu Banxia shook his head in resignation.

"Well, it’s because everyone is working so hard and proactively today that I have a bit of downtime." Liu Yiqing said.

"However, the patient’s condition seems to be progressing faster. It can’t just be the spleen causing the clotting time to be delayed."

"Now, it’s a metabolic problem. I’m concerned there might be issues with other organs as well. Rhabdomyolysis inherently has a degree of renal failure. The spleen being like this, the liver also affected, an onset of multiple organ failure would be dangerous."

"Uh... Teacher Liu, why are you looking at me like that? Maybe it’s just the patient recovering slowly now?"

The more Liu Yiqing spoke, the more uncertain she sounded.

"Come with me, let’s go see the patient." Liu Banxia said, then headed for the elevator.