The Enhanced Doctor-Chapter 496 Swollen head due to unknown cause
DING! Consultation Complete.
100 experience points gained, 50 points in Diagnostic Skills proficiency, 50 points in Wound Dressing Skills proficiency.
The rewards from these two cases weren’t much, mainly because the diagnoses were too obvious and didn’t require much thought.
The first patient knew he had urticaria. The second, despite still saying, "the larger the blister, the more damp-heat," had proactively reported his cupping therapy, which indicated his own doubts.
This patient’s blood test results were quite clear, showing a significant increase in white blood cell and neutrophil counts. Seeing this, further speculation was unnecessary; it was at least in the early stages of an infection.
Sepsis develops rapidly. Some people with strong constitutions might not experience any issues. However, for those with weaker physiques, even a single opportunity for bacteria to attack can wreak havoc.
However, the patient’s liver and kidney function results weren’t back yet, so there was no immediate need to transfer him to the ICU.
"Body temperature is 39.6 degrees Celsius. Apply Physical Cooling. It’s highly likely Staphylococcus aureus. For antibiotics, let’s use vancomycin. Once the liver and kidney function results are out, we’ll make appropriate electrolyte adjustments if necessary," Liu Banxia prescribed.
"Teacher Liu, why doesn’t the state regulate these physical therapy clinics? It seems like many incidents have occurred because of them in recent years, haven’t they?" Xu Yino asked.
"Regulate? How could we regulate them? Physical therapy isn’t considered medical practice; you can’t judge them by the standards of medical institutions," Liu Banxia said, shaking his head.
"There are plenty of therapies out there, like trying to find a needle in a haystack. Most of them use air cups, though. After cupping, one does feel a certain lightness. But these fire cups... they’re genuinely dangerous."
Of the two patients this morning, one case was minor, but the other, especially the second patient, was quite critical. Hopefully, vancomycin will prove effective and spare him further suffering.
Liu Banxia pondered for a moment and suddenly realized something. Why weren’t there many patients now? And why did the second patient come directly to me?
He glanced over and saw Wei Yuan and the others huddled together. It’s pretty obvious they’re trying to ’isolate’ me, so the patient came directly to me.
"You guys are too mischievous," Liu Banxia said helplessly, walking over to them.
"You’re always busy running around and working elsewhere. You should pick up some work in the hall too. We’re looking out for you; you can eat lunch first today," Wei Yuan said with a smile.
"I’m so hard done by, all this effort and nothing good to show for it. But, it’s almost lunchtime. Aren’t you all going to enjoy this rare quiet moment?" Liu Banxia asked.
"You can pour all your energy into the night shift. Patients will start trickling in around 4:00 p.m.," Wang Chao said.
"Sigh... I really don’t get what’s so great about drinking. Drinking in moderation should be enough, right? I don’t know when it became a measure of a strong relationship to see who can drink the other under the table," Liu Banxia lamented.
"What’s wrong? Why so many sighs today?" Shi Lei asked, curious.
"Xu Yino, report the details of today’s second case," Liu Banxia said.
Xu Yino, standing nearby, quickly gave her report, making sure to emphasize Liu Banxia’s views on "folk fallacies."
"This issue is indeed difficult to handle, especially since the practitioners are a mixed bag. Basically, anyone can offer these services," Shi Lei commented.
"I remember when I first came to the Second Hospital, I treated a patient who developed an infection after his skin was broken during a Gua Sha treatment."
"He endured it at home for four or five days before finally coming to the hospital. It was really dangerous then; we almost couldn’t resuscitate him. Initially, it was treated as a common cold, but his condition just got progressively worse."
"It’s not just cupping and scraping, but also moxibustion. Improper procedures can easily burn the patient’s skin. There are actually many such cases every year, but most people seek timely medical treatment, and debridement usually resolves the issue."
After chatting idly for a while, Liu Banxia saw it was about time and led the large group of interns to the dining hall.
Such a scene had been rare in the past two months, only really happening when the emergency center first opened. Even Liang Xiaolin joined the bustling group; she had been part of the intern team back then, too.
After lunch, he chatted briefly with Qiaoqiao on his way back. If he wanted to talk more, he’d have to wait until bedtime.
This is the only time I can truly call my own. Otherwise, it’s all work. Patients or their families would feel uncomfortable if they saw me constantly on my phone.
He also went to the ward to check on the patient. It was still too early to tell if the antibiotics were effective, but at least the patient’s condition wasn’t worsening.
"Xu Yino, keep a close eye on this patient. Handle what you can, and report to me if you can’t," Liu Banxia instructed.
Xu Yino nodded and roped Liu Yiqing in.
This was a small task Liu Banxia had assigned her; she also needed to observe Liu Yiqing’s state of mind.
Just as he returned to the emergency center, he saw Xu Hui walking out of a consultation room. Upon seeing Liu Banxia, Xu Hui immediately waved him over.
"Why haven’t you gone to eat yet?" Liu Banxia asked.
"I just admitted a patient, and the situation is a bit complicated. Her face is swollen, looking like it might be an allergic reaction. I gave her a shot of dexamethasone, but so far, the symptoms haven’t subsided," Xu Hui said.
"Let me take a look. Is it that serious?" Liu Banxia asked with a frown.
Xu Hui nodded.
Following Xu Hui into the patient’s room, even the experienced Liu Banxia was taken aback when he got a clear look at the patient.
Swelling was an understatement; her entire head had ballooned. Her eyes were swollen to mere slits, her lips and cheeks were also severely enlarged, and she was struggling to open her mouth, breathing with difficulty.
The patient was a 21-year-old girl, and she was clearly in great distress.
"Any history of allergies?" Liu Banxia asked, even though he knew Xu Hui must have already inquired.
"She’s not allergic to anything. Eats well, sleeps well. A few days ago, her feet were a bit swollen, but it went away. We didn’t think much of it. Then, this morning, she ended up like this," the patient’s mother said.
"After the medication, do you feel any different? You don’t need to speak, just nod or shake your head," Liu Banxia said, looking at the patient.
The patient shook her head with difficulty; what would normally be a simple gesture was now arduous for her.
"Doctor Xu, what about the blood test results?" Liu Banxia asked Xu Hui.
"The complete blood count is normal, and we’re still waiting for the allergen screening results. However, I don’t think any allergy could cause symptoms like these, right?" Xu Hui said. "Moreover, this sort of condition is often caused by an external viral intrusion. But the girl has been at home all this time. Her diet and daily routine haven’t changed, and no one else in the family has felt any discomfort."
"Doctor, use whatever medicine you need, no matter how expensive. You have to reduce our child’s swelling!" the patient’s father exclaimed.
"Please, try not to worry just yet. We need to treat the cause appropriately. Using the wrong medication could worsen her condition," Liu Banxia said.
"How can we not worry? Our child is struggling to breathe! Isn’t there something on TV, adrenaline? Can’t you give her a shot for allergies?" the patient’s father asked.
"Adrenaline is typically used for severe anaphylactic shock. If dexamethasone isn’t helping your daughter, and if this isn’t the right diagnosis, other anti-allergy medications likely won’t be very effective either," Liu Banxia explained.
"Then what do you suggest we do?" the patient’s father asked, his voice edged with panic.
Liu Banxia understood his feelings and didn’t take offense. "Brother Xu, I don’t know how this condition will progress. But I’m worried about laryngeal edema. To protect her airway, I suggest we intubate her proactively."
"What’s intubation? If she’s intubated, will she become a vegetable?" the patient’s mother asked anxiously.
"Intubation is a way to protect the airway. We don’t currently know how the child’s condition will develop," Xu Hui quickly explained.
"The child is currently showing some symptoms of an allergic reaction, which often resolve on their own. However, if her condition worsens instead of improving, it may likely lead to laryngeal edema."
"The intubation we’re talking about is a protective measure for the trachea. Once intubated, although she won’t be able to move much, it will safeguard her airway. Even if laryngeal edema occurs, the child will not suffocate."
The parents exchanged a look, then turned to their daughter. She nodded with difficulty.
Breathing was already a struggle for her; she would agree to anything that could make it easier.
"Liang Xiaolin, come here. Hmm... find an empty ward upstairs and prepare the patient for intubation," Liu Banxia called out.
This was also part of his consideration. It was inappropriate for this patient to wait in the emergency hall. Even if she were moved to an occupied ward, she would attract attention, and her parents would undoubtedly become even more agitated.
DING! Task Issued: The Girl with the Swollen Head.
Open Task: At Xu Hui’s consultation request, a patient presents with unexplained head swelling, posing a suspected life-threatening risk. The host is required to make a diagnosis. Task rewards will be issued based on the diagnostic results.
"Banxia, thanks. I didn’t even think about protecting the airway in advance," Xu Hui said after Liang Xiaolin had taken the patient away.
Liu Banxia shook his head. Why is he being so polite? Maybe this is superfluous. The real issue is, what caused this swelling?
An insect bite? If it were an insect bite causing this much swelling, there would be specific signs. Besides, what kind of extremely venomous insect would it have to be? She wouldn’t still be alive if that were the case. 𝘧𝑟𝑒𝑒𝘸𝘦𝘣𝑛𝑜𝘷𝑒𝓁.𝘤𝘰𝓂
"Sigh... I’ve checked her scalp thoroughly and found no abnormalities," Xu Hui said with a sigh.
"Let’s observe for now and wait for the toxin and allergen screening results," Liu Banxia said.
This was the first time he had encountered such a case. He had seen patients with localized swelling, but never someone whose entire head had swollen so severely.
