The Enhanced Doctor-Chapter 419: Postoperative Infection

"How are you feeling? If it’s very painful, tell me the truth. Don’t try to endure it."

Liu Banxia approached the bedside of the young man with appendicitis.

"It’s not... very painful..." the patient said with difficulty.

Liu Banxia frowned. He had been notified by Zhou Qian that the patient’s condition seemed to have worsened. Although the patient vehemently denied it, the expression on his face betrayed him.

"Are you gambling with your life? If it actually perforates, you’ll be close to death. Let’s do another ultrasound," Liu Banxia said.

The patient glanced at him. Though still reluctant, he lifted his shirt.

Liu Banxia performed another ultrasound. Looking at the displayed images, he sighed inwardly. "If you had held out for another half hour, it very likely would have ruptured. At that point, even if the surgery were successful, the risk to you would be extremely high."

"Look, this is your appendix now, and this image is from when you first arrived. Compare them yourself. This is incredibly dangerous."

It was a good thing Zhou Qian had discovered this in time; otherwise, the outcome would have been dire.

"Wang Chao, the appendicitis is suppurating. Schedule an operating room," Liu Banxia called out.

"Doctor, can’t we wait a little longer?" the patient asked.

"Wait longer? Didn’t you hear what I just said? If we wait any longer, it will be too late. You could very well end up in the ICU," Liu Banxia said, his expression calm.

The patient opened his mouth. For some reason, Liu Banxia’s calm words made him feel somewhat frightened.

Ding! Consultation complete.

Experience points gained: 100, Diagnostic skill proficiency: 100.

He didn’t need to manage the rest; Wang Chao would handle it. Whether it was laparoscopy or a conventional incision, the patient just had to choose.

He was truly disappointed in this patient. He had explained everything clearly, including the risks, yet the man still wanted to "muddle through." Who was he trying to fool? Not the doctor, but himself. The price he might have to pay could be his own life.

"President Liu, a car accident patient who had a chest tube inserted on-site is being brought in now!" a dispatch nurse called out.

"Liang Xiaolin, prepare to receive the patient with me. Notify a cardiothoracic surgeon and prepare two units of O-positive blood," Liu Banxia commanded.

This patient’s condition must be critical; otherwise, they wouldn’t have inserted a chest tube on-site.

"The patient is a nineteen-year-old male. He lost consciousness after being put in the ambulance. Blood pressure is 70/90, heart rate 130, chest tube inserted on the left side," the paramedic accompanying the patient reported.

"Resuscitation Room Two. Was the patient’s chest impacted?" Liu Banxia asked.

"It seems so. The driver at fault was intoxicated and was taken away at the scene," the traffic police officer who had come along said.

"One, two, three, lift! Connect the monitor, prepare for an X-ray, and book an OR," Liu Banxia instructed after entering Resuscitation Room Two.

"What’s the situation?" Just then, Chen Xuehai also hurried into the resuscitation room.

"We’re about to take an X-ray. He likely has rib fractures. It’s hard to say about internal organ damage yet," Liu Banxia said.

BEEP! BEEP! BEEP!

The monitor, just connected, began to alarm frantically.

"Blood pressure and oxygen saturation are dropping rapidly! Oxygen saturation is 76!" a nurse reported urgently.

"One hundred milligrams of succinylcholine, twenty milligrams of etomidate! Miao Rui, intubate! Check head and neck! Liang Xiaolin, establish IV access and start blood transfusion immediately!" Liu Banxia ordered.

At Liu Banxia’s commands, Miao Rui and Liang Xiaolin sprang into action.

Liu Banxia wasn’t idle either. While they performed resuscitation, he began his physical examination of the patient.

"He has rib fractures. Let’s do an ultrasound first to check for abdominal hemorrhage, then get the X-ray," Liu Banxia said.

Chen Xuehai nodded. Liu Banxia’s decision was correct; the patient’s blood pressure had dropped too quickly. Even though Liang Xiaolin had already started the blood transfusion, it had only raised his blood pressure slightly.

"This is bad! No fluid in the abdomen. Everyone, step back for the X-ray!" Liu Banxia said, suddenly anxious after the ultrasound.

At his command, everyone moved aside. The radiology technician positioned the X-ray plate and took the image.

"The left hemithorax is completely opacified, and the mediastinum is shifted to the right. This is a tension hemothorax! No time to get to the OR! We have to open his chest here! Thoracotomy tray! Twelve-millimeter chest tube!" Chen Xuehai commanded, hurriedly pulling on gloves.

Liu Banxia stepped back. This was exactly what he had feared.

The patient’s precipitous drop in blood pressure definitely indicated a serious internal problem. No fluid in the abdomen meant the issue had to be in the chest. And now, the X-ray findings were dire.

Chen Xuehai’s expression turned grave. He too had a very bad feeling.

BEEEEEEP...

A long, flat tone sounded from the monitor. Chen Xuehai stopped what he was doing.

"Time of death: 9:42 a.m. After opening the pericardium, we found the right atrium had avulsed from the vena cava," Chen Xuehai announced grimly.

Ding! Consultation complete.

Experience points gained: 100, Diagnosis skill proficiency: 100, Orthopedic skill proficiency: 50.

"Officer, please contact the family. We’ll take him to the morgue after we’ve closed," Liu Banxia said, stepping out of the room.

The traffic police officer nodded, also shocked by how quickly things had deteriorated.

Losing a patient was something no one ever wanted to experience. Even though this patient was an emergency admission, the impact was just as heavy, especially since he was so young.

"Doctor Qi, are there any particular surgeries you’d like to focus on consolidating recently?" Liu Banxia asked Qi Wentai, who had just finished a consultation.

"Hmm... perhaps intestinal procedures. I’m quite confident with common surgeries like appendectomies and cholecystectomies, but I’m a bit weaker in intestinal surgeries," Qi Wentai replied.

Liu Banxia nodded. "Alright, we’ll try to assign you more of those cases. When you operate, bring the interns along so they can observe more."

"Okay," Qi Wentai nodded decisively.

Nowadays, Qi Wentai’s old views of Liu Banxia had completely vanished. In terms of work ethic and management, Liu Banxia was impeccable. Moreover, Liu Banxia’s current surgical abilities had far surpassed his own.

Even Wang Chao often preferred Liu Banxia to be present during his surgeries to offer guidance.

At this stage, Liu Banxia generally delegated such minor surgeries to others, giving them opportunities to hone their skills.

Just then, Wang Chao walked over. "President Liu, the surgery was a success. The appendiceal wall was already paper-thin; it was on the verge of perforating."

"Good job," Liu Banxia praised. "Your surgical skills have clearly improved, finishing so quickly this time."

"The patient opted for a conventional incision, which made it less complicated. Besides, appendectomies are a core procedure for our Emergency Center; I couldn’t let you down," Wang Chao said earnestly.

"Good, that’s the spirit. As a reward, you can cover the lunch shift today and eat afterward," Liu Banxia replied with equal gravity.

Wang Chao shot him a resentful glare but didn’t dare to argue.

Seeing a covered body being wheeled out of Resuscitation Room Two, Wang Chao frowned. "Just handled an emergency?"

"A car accident victim. His right atrium was torn from the vena cava. There was no chance to save him; he had no vital signs by the time we performed the thoracotomy," Liu Banxia explained.

Wang Chao nodded. Even without witnessing it firsthand, he could imagine how grim the scene must have been.

"Keep an eye on these interns for me," Liu Banxia said. "Their technical skills are decent, but they lack real-world experience. No matter how many of them end up staying, we need to train them thoroughly."

"Actually, they’re really quite good," Wang Chao replied. "Much better than I was during my residency training, anyway. Besides, you’re their attending physician; you can’t just push all the responsibility onto me. I actually feel a bit pressured supervising them now; they’re all quite capable."

"That’s precisely why you need to push yourself harder," Liu Banxia advised. "Try to sleep less, read more, and get into more surgeries."

Just then, the alarm indicator for the surgical inpatient ward lit up.

"Damn it! I think that’s my patient!" Wang Chao exclaimed, immediately breaking into a run. Liu Banxia didn’t hesitate, sprinting after him toward the ward.

This was the advantage of the new system. Otherwise, the call would have gone to the nurses’ station first, and then a nurse would have had to page them.

"What’s wrong?" Wang Chao asked, breathless, as he reached the ward.

"Teacher Wang, his temperature shot up to 39 degrees Celsius, and his blood pressure dropped to 50/80," Su Wenhao reported quickly from inside the room.

Liu Banxia lifted the patient’s blanket and removed the gauze dressing from the incision. "The incision is clean, no signs of inflammation," he observed. "There are stains on the bed linen; it looks like fecal discharge."

He then issued a series of orders: "Administer oxygen. Draw blood for a full chemistry panel, toxin screen, and bacterial cultures—tell the lab to expedite. Two grams of meropenem and five hundred milligrams of paracetamol IV. Perform cardiac and abdominal ultrasounds."

The nurses nearby sprang into action.

"President Liu, what’s going on? Is it an infection?" Wang Chao asked, his voice tinged with fear.

Liu Banxia’s brow was furrowed. "It’s unclear right now. Your incision site looks perfect, with no signs of infection or inflammation there."

"But the sudden high fever and plummeting blood pressure are consistent with sepsis. Su Wenhao, what are the findings on the cardiac and abdominal ultrasounds?"

"Teacher Liu, the EKG, cardiac ultrasound, and abdominal ultrasound are all normal," Su Wenhao replied.

Ding! New Task: Postoperative Patient with Sudden Onset Infection.

Patient, admitted unconscious, developed a sudden infection post-appendectomy. Further diagnosis required to identify the etiology. Task rewards will be based on diagnostic results.

Although a new task notification had popped up, Liu Banxia paid it no mind. His focus was entirely on auscultating the patient’s lungs and heart. This sudden infection was a real bastard to deal with.

The patient’s condition had stabilized somewhat for now. But what could be causing the loss of sphincter control and the fecal incontinence? It might be related to the high fever from an infection, but that just brought him back to the original question: what was the source of this infection? The surgical incision was immaculate.