The Enhanced Doctor-Chapter 439, whoever enters first prevails
(Thank you to friends Transforming Ultraman, Book Friend 110316151302234, and Book Friend 2019072705832637 for their monthly ticket encouragement.)
Inserting the needle was not as hard as Liu Banxia had imagined. He had overcome this small mental hurdle, and during the rest of his shift, every baby in need of an IV insertion got one from him.
However, despite his efforts, he was unable to take care of everyone by himself.
It was still because the pediatric ward had too many young patients; some of the slightly older children also had to be handled by other nurses.
"Has that child’s condition improved?" After a busy period, Liu Banxia approached Chen Hongyang again.
Chen Hongyang shook his head. "Still the same, he still has difficulty breathing. He’s been put on oxygen, which has relieved him somewhat."
"Don’t worry too much about it for now. Once it’s time for lunch, I’ll grab a bite, let my mind relax a bit, and then come back to help you think it over properly," Liu Banxia said.
Chen Hongyang nodded. This case was indeed complex, and Liu Banxia had already been of great help to the pediatric department today.
He was the chief resident, after all; he couldn’t be tethered to the pediatric department all the time.
"Qing Kewa, what are your thoughts on celebrating the Spring Festival here at our hospital?" Liu Banxia asked during their meal in the cafeteria.
"Can we have a barbecue and drink beer?" Qing Kewa pondered before asking.
"Don’t count on barbecue and beer. In the hospital, you can at least have chicken legs and dumplings," Liu Banxia said with a smile.
"I’ll discuss it properly with the cafeteria. Everyone should list a dish they like. We need to celebrate the Spring Festival and the first day of the lunar year properly."
"Wow, President Liu, that’s quite generous of you. There are quite a few medical staff members in the Emergency Center too," Wang Chao said, grinning.
"We’ve worked hard all year; we deserve to enjoy the festival," Liu Banxia responded.
"If we can’t go home to reunite with our families, let’s celebrate here in the hospital together. The sentiment of the Spring Festival is surely different from other holidays, and this is our first Spring Festival at the Emergency Center."
Everyone cheered up. Truth be told, they now had something to look forward to this Spring Festival.
Working during the holidays is tough, and just as Liu Banxia had said, the sentiment of the Spring Festival is indeed somewhat different.
After finishing lunch and returning to the Emergency Center for the shift change, Liu Banxia found himself pondering the child’s asthma issue again.
Based on what he could assess, the child’s episode of febrile seizure and the current exacerbation of asthma were definitely directly related. Mere pondering wouldn’t solve this complex case; he had to see the little patient directly.
He originally wanted to discuss this with Xu Hui, but Xu Hui was also swamped with patients. I’ll consult with Xu Hui if there are no new discoveries after examining the child, he decided.
This was one of the challenges resulting from the surge in patients—getting an internal medicine consultation was quite troublesome. In Internal Medicine, only Wang Huan and Xu Hui were on rotation, and the two interns, Zhou Shangkai and Cao Peng, couldn’t handle patients independently yet.
He had also looked up some information on asthma; the disease was truly vexing. Especially during an attack, that suffocating, breathless feeling, though not painful, must be incredibly uncomfortable.
As soon as Wei Yuan and the others returned from lunch, Liu Banxia slipped back to the pediatric department.
"Would you like to check on the child? He’s a bit better right now. He’s in the ward," Chen Hongyang said.
"Let’s go take a look. I can’t figure this out just by thinking about it. If I still can’t understand it after seeing him, we’ll have to call in people from the inpatient department for a consultation. That would really be our last resort," Liu Banxia said.
"My thoughts exactly. It would be best if we could solve it in the Emergency Center, though," Chen Hongyang nodded in agreement.
Upon reaching the ward, they found the child reclining on the bed, sipping yogurt. The parents sat by his side, their faces fraught with worry. The bento boxes on the cabinet remained unopened.
"This is Dr. Liu from our Emergency Center. I’ve invited him here to help with the diagnosis," Chen Hongyang introduced.
"Do we need to do any more tests? I’ll go and pay right away," the child’s father stood up.
"Don’t rush. The child’s asthma is quite complex, so we can’t just conduct tests randomly," Liu Banxia replied.
"Have you noticed any obvious triggers before the child’s asthma attacks, like cold air, second-hand smoke, or smog?"
The parents pondered for a moment, then shook their heads in unison. This time, the mother spoke up, "Nothing specific. Each incident seems to be a bit different."
"What about before? At what age was the child diagnosed with asthma?" Liu Banxia asked.
"When he was four. The doctor said it might improve as he got older and his immunity strengthened. But it didn’t. In fact, it has gotten worse," the mother said.
"Doctor, is this also related to the febrile seizure he had two months ago? It seems like ever since then, his asthma attacks have become more frequent. The inhaler used to work, but it didn’t today."
The child’s father furrowed his brows and glanced at the child’s mother.
Liu Banxia began to ponder. This medical history is quite long.
He looked at the child again. The child was thin, his face wearing a pinched expression; even while sipping yogurt, he showed little joy. His breathing was still labored; after a couple of sips, his wheezing would become more pronounced. 𝕗𝕣𝐞𝐞𝘄𝐞𝚋𝚗𝗼𝘃𝗲𝗹.𝚌𝕠𝚖
"What about his usual diet?" Liu Banxia persisted.
"We’ve been extremely careful with his diet, giving him only the foods he usually eats. There doesn’t seem to be any problem there; even his soup is always cooled to lukewarm before he drinks it," said the child’s mother.
"Whenever he wants to go outside and play, I make him wear a mask, afraid that the dirty air outside might trigger another attack. We’ve tried everything we could think of in the last two years, even some folk remedies, but there has been no improvement."
"Some say it could be hereditary, but none of our relatives on either side have this disease. We’ve even considered moving south because people say the air is better there."
"I’m going outside for a smoke." At this point, the child’s father stood up.
"Smoking, that’s all you know! Can’t you spend a little more time with our child?" The mother’s voice rose sharply.
"Would he be like this now if you hadn’t insisted on taking him out to play? You’re out all day; do you have any idea how hard it is for us two at home?"
The child’s father glanced at her but said nothing.
"Mom, HUFF... HUFF... HUFF..." At this moment, the little boy on the hospital bed cried out, then clutched his chest and began gasping heavily. His attack had started, right at that moment.
Chen Hongyang didn’t dare delay, immediately turning on the nebulizer beside the bed and placing the mask on the child.
Liu Banxia furrowed his brow. Could the trigger for the child’s asthma be psychological?
"Were you two arguing when the child had his attack at home today?" Liu Banxia asked.
The couple paused, then nodded.
"Then try to recall, during his previous attacks, were they always due to emotional... Hmm. Wait a moment," Liu Banxia said, then paused mid-sentence, pulled out his stethoscope, and began to examine the child.
He listened to his lungs first, then his heart.
"President Liu, have you figured anything out?" Chen Hongyang asked urgently as soon as Liu Banxia removed his stethoscope.
"Let’s do an electrocardiogram and an echocardiogram. I just heard some friction rubs. It might be cardiac asthma. The previous febrile seizure might not have been a true febrile seizure, but rather caused by a cardiac event," Liu Banxia said.
Chen Hongyang was stunned and quickly called the nurses to bring the equipment. This was very plausible, and yet he hadn’t thought of it during the consultation.
The equipment was wheeled over. The ECG was done first, but the results made Chen Hongyang frown; surprisingly, there were no abnormalities.
"That’s a good thing. It means the child’s heart condition isn’t very severe," Liu Banxia said.
"Now that the child’s breathing has returned to normal, it shows he has passed this cardiac episode. My feeling is that it’s myocardial ischemia. Let’s be direct and do a coronary angiography."
"Otherwise, we’d have to do a stress test to induce myocardial ischemia and see it on the ECG. Considering the child’s current age and his age when the symptoms first appeared, I suspect it might be caused by a coronary artery malformation. It could be a very small anomaly, easily overlooked."
"How did you come to this conclusion?" Chen Hongyang furrowed his brow.
"They must have checked his heart in previous examinations. I also recall the X-ray; the heart contour was basically normal. The ECG just now was normal again. So, it can only be a problem with blood supply," Liu Banxia explained.
"Recovering this quickly points to an arterial malformation, likely a small one. When the child calmed down, his blood supply normalized."
"The patient we admitted to the ER today, the one we rescued, had a myocardial infarction. It was visible on the ECG, so we proceeded directly to coronary angiography."
Chen Hongyang thought for a moment and nodded, then began to explain the coronary angiography procedure to the child’s parents. He was now leaning towards Liu Banxia’s judgment. If the malformation was indeed very small, even an echocardiogram might not detect it, making it a waste of time. The child’s symptoms currently appeared and resolved quickly, which strongly suggested the malformation was small, just as Liu Banxia suspected.
As for this matter, the child’s parents had no reason to disagree.
Liu Banxia didn’t go with them. He was very confident in this diagnosis, even though the system hadn’t given any prompts yet. Now, it could be said that all other impossibilities had been eliminated; this was what cardiac asthma looked like. An echocardiogram would have been more useful if there were changes in the child’s heart proportions.
A short while later, he received a text message from Chen Hongyang: it was indeed an arterial malformation.
*Ding! Complex Asthma Task completed.*
*Reward: 200 experience points, 100 points in Diagnostics skill proficiency.*
Looking at the meager rewards, Liu Banxia paused for a moment, then shook his head in resignation.
Preconceptions are truly a hindrance! Both he and Chen Hongyang had been fixated on the airways as the cause. That’s why they hadn’t considered the heart at all. It was actually a relatively simple case. If they had done a comprehensive examination at the Emergency Center from the start, it wouldn’t have taken this long.
