The Enhanced Doctor-Chapter 531 Complex Rash Patients

(Thanks to Comet 7 Yao, Paint Years, mwx80, free_liu, Call Me Over, xmd11 for their encouragement in the form of monthly tickets)

"Is everything alright downstairs?" Liu Banxia asked after returning to the hall.

"Nothing much, just not getting enough rest. We really should take another day or two to fully recover," Wei Yuan said with a smile.

"Don’t rush, take it slow. For now, at least, I can guarantee you’ll have at least three days of rest each month. Once other departments are also staffed up, we can have proper, regular days off," Liu Banxia said.

"We’ll get through this. There will be bread, and there will be milk. We’re relatively relaxed right now; you haven’t seen how busy the other departments are."

"Will Obstetrics and Gynecology be starting soon?" Wei Yuan asked.

Liu Banxia nodded. "Obstetrics and Gynecology will be first, then we’ll fill up the CCU beds. After that, we’ll add more attending physicians to Internal Medicine—Cardiology, Cardiac Surgery, Neurology, and Neurosurgery. We’ll need at least one more attending for each of those."

"ENT, Urology, and Proctology—those haven’t been finalized yet. Plastic Surgery will also be established. Then, patients with cosmetic needs can be referred to them."

"Everything should be in place before May 1st. By then, we’ll be a truly formidable team. After all, our emergency center is the key focus of the entire hospital."

"At least there’s something to look forward to," Wei Yuan said thoughtfully.

"Speaking of which, are you really not going to operate on that patient with congenital megacolon? His condition is quite severe. Won’t he need surgery sooner or later anyway? If he does it now, it’ll be easier for him."

"I’ve tried to persuade him, but he still chooses conservative treatment," Liu Banxia said, sounding somewhat helpless.

"There are at least 3 kilograms of stool retained in his colon, and some of it has hardened into fecaliths. Even so, he adamantly insists on conservative treatment first."

"He believes that by controlling his diet and establishing a daily bowel habit, he can manage the condition. But it’s not that easy to control. It sounds simple, but actually doing it is another matter."

"Encountering such patients can sometimes be the most troublesome, as they often overestimate their willpower. And once they feel a bit better, they tend to let their guard down."

"Now we just have to wait and see how long it is before this happens again, and whether he develops enterocolitis. We’re anxious, but it’s no use. To put it bluntly, it’s a case of the attendants worrying more than the emperor himself."

"Sometimes—"

Before Liu Banxia could finish, the alarm light in the emergency center hall flashed—it was coming from an Internal Medicine consultation room. Without a second thought, he ran straight in.

"Get the defibrillator and monitor! She suddenly developed respiratory distress. I’ve given 1 unit of epinephrine," Xu Hui said.

"How is she now?" Liu Banxia asked.

"Her breathing has improved slightly. Should we intubate for airway protection, do it preemptively?" Xu Hui asked.

"Wait a moment, didn’t her family come with her?" Liu Banxia asked as he helped apply the monitor patches.

"She came alone. Luckily, her blood oxygen is coming up. That really scared me just now," Xu Hui said, wiping the sweat from his forehead.

"The patient works in a restaurant kitchen, washing vegetables and meat, and has been working overtime recently. She has rashes on her hands and arms; I suspect contact dermatitis. Before I could even prescribe medication, she suddenly went into respiratory distress."

BEEP BEEP BEEP... BEEP BEEP BEEP...

As soon as Xu Hui finished speaking, the monitor began to shriek.

"Cardiac arrest! 1 unit of epinephrine. Defibrillate at 150 joules, get ready."

Liu Banxia spoke while performing chest compressions on the patient.

Xu Hui hurried to operate the defibrillator.

"Charged. Clear!"

CRACK!

"200 joules!"

"Charged. Clear!"

CRACK!

"Phew... Okay, we have a heartbeat. Blood panel, blood chemistry, echocardiogram, chest CT. Zhou Shangkai, you go with her," Liu Banxia said.

Zhou Shangkai hurriedly nodded.

"My God, I can’t believe I’m getting such a critical case on my first day back. President Liu, what’s your initial assessment?" Xu Hui asked.

"Besides cardiopulmonary issues, could it be infectious? Let’s wait for these test results before we say more," Liu Banxia said.

"It’s a good thing you had the nurse push the defibrillator over. Otherwise, bringing it now would have wasted precious time."

"I was a bit panicked. After all, we don’t often encounter patients like this in Internal Medicine," Xu Hui shook his head.

"The patient is 42 and has been working constantly lately. Even though it’s the New Year holiday, the restaurant is still very busy, mostly with banquet reservations."

"The patient worked so much overtime because she wanted to earn more money. She’d been feeling fatigued, and rashes had appeared on her hands and arms in the last couple of days."

"Work was lighter this morning because the restaurant hired two new vegetable washers, so she finally had a chance to come to the hospital. This disease progressed incredibly fast."

"We’ll see what the test results say. I’ll stay here with you for now," Liu Banxia reassured him.

This was a normal reaction, and he understood.

If doctors are drivers, then emergency physicians are like Formula 1 racers, always fighting against the clock.

Internal medicine doctors, while also licensed drivers, mostly handle short and long hauls, occasionally hitting city traffic jams.

Put them on a racetrack, and their adrenaline would surge. Afterwards, they’d be exhausted and weak. That’s perfectly normal.

However, this patient’s current condition was indeed very serious; they’d already had to use the defibrillator on her. If the cause and specific condition couldn’t be identified, the next crisis could occur at any moment.

Fortunately, today was a regular workday with fewer patients, so Wei Yuan and Qi Wentai outside could manage the patient flow to some extent.

In the emergency center, most patients—whether arriving by ambulance or as walk-ins—are typically surgical cases.

"Ah... I’ve finally calmed down a bit."

Ten minutes later, Xu Hui let out a long sigh of relief.

"I was just pondering this patient’s condition," Liu Banxia said. "The rash on her hands and arms—could it be an allergic reaction?"

"Based on the symptoms, it’s certainly possible. But if it’s an allergic reaction, what allergen in the hospital could cause respiratory distress and cardiac arrest?" Xu Hui countered.

"That’s exactly what I can’t figure out. I was just thinking of calling the lab to run an allergen panel," Liu Banxia said with a rueful smile.

Xu Hui had a point.

The patient had been fine upon arrival and then suddenly deteriorated in the hospital. If it was an allergen, it would have to be something in the hospital.

But Xu Hui hadn’t administered any other medication besides the emergency epinephrine.

The hospital maintains high standards of hygiene and infection control. The patient hadn’t come into contact with any unusual substances, so the sudden deterioration might have been spontaneous.

At that moment, Xu Hui’s phone rang. He quickly answered it and put it on speaker.

"Teacher Xu, I’m in the CT room. Preliminarily, the chest scan looks clear. I don’t see any inflammation or space-occupying lesions," Zhou Shangkai reported.

"Okay, we’ll look at the echocardiogram later," Xu Hui said and ended the call.

"We might have to do a lumbar puncture later to check for meningitis," Liu Banxia added.

Xu Hui nodded. "If we can rule out cardiopulmonary issues and the blood tests are normal, it really could be encephalitis."

"So, that would mean two separate conditions: contact dermatitis and encephalitis? But her temperature wasn’t high during the initial physical exam."

"Let’s not jump to conclusions," Liu Banxia shook his head. "We should wait for the next set of results."

Without definitive test results or clear indicators, any speculation is pointless. We’re essentially fumbling in the dark right now. What kind of guesses can you make under these conditions?

After a while, the rest of the results came in. All tests were negative.

Xu Hui and Liu Banxia looked at each other. Although they had already discussed performing a lumbar puncture, they still needed to explain it to the patient. After all, it’s an invasive procedure, not as simple as a blood draw.

The patient was wheeled back. Her condition was slightly improved compared to immediately after the resuscitation.

While defibrillation is life-saving, the electric shocks are very painful for the patient.

"Currently, all your test results are inconclusive. We suspect it might be meningitis, so we need to perform a lumbar puncture," Xu Hui stated.

"Can you remember any other symptoms? Including the rash on your hands—how many days has it been there? Do you have rashes anywhere else on your body?"

The patient shook her head with some difficulty. "Just on my hands. A lot of us in the kitchen get this. It’s from handling meat and detergents so much; our hands get raw."

"Based on our current assessment, the next step is a lumbar puncture to examine your cerebrospinal fluid," Xu Hui explained.

The patient nodded.

There were no surgical interns present this time, so Liu Banxia had to perform the procedure himself.

After drawing the sample, he quickly sent it for examination.

"Brother Xu, it really might be meningitis. When I was performing the tap, I noticed the cerebrospinal fluid pressure was a bit high," Liu Banxia said, pulling Xu Hui aside.

"But you saw it too, didn’t you? The patient also has some rashes on her back. Now I’m wondering again if it could be an allergic reaction. If it were just contact dermatitis, it wouldn’t likely be on her back, would it?"

Xu Hui nodded. "This patient’s condition has me thoroughly confused. Her case is likely very complex. Let’s do an allergen test as well. I won’t feel at ease otherwise."

After this discussion, they decided to proceed with both.

It was a necessary step. Initially, the patient’s own account and the preliminary examination only pointed to rashes on her hands and arms, consistent with contact dermatitis.

Even the patient herself had said that kitchen staff who frequently wash vegetables and meat often experience similar issues.

This was understandable. Detergents can erode the skin’s protective barrier, and meat is often treated with numerous disinfectants during processing to ensure bacterial counts are within limits for sale.

Although this felt a bit like locking the stable door after the horse has bolted, it wasn’t entirely too late. As long as the wolf hadn’t carted off all the lambs, there was still a chance for rescue.