The Enhanced Doctor-Chapter 534: Rapid Increase of Pus

(Thanks to idlers, baochong, xmd11, mangmangliu for their encouragement with monthly tickets)

"Teacher Liu, these are the X-ray and blood test results of the patient we just saw."

Su Wenhao came over with the test report and X-ray films.

Liu Banxia inserted an X-ray film into the light box. "Give me your diagnosis."

"The patient’s white blood cell count is elevated, and there’s an increased neutrophil ratio. The images show evidence of pleural effusion in the patient’s right chest, suggesting it may have already suppurated," Su Wenhao said.

Liu Banxia frowned. "Are you sure that’s the only diagnosis you’re offering?"

Su Wenhao chuckled. "Teacher Liu, don’t try to trick me. I’m very confident in the diagnosis based on these test results."

"Well, you’ve grown. What’s the next step?" Liu Banxia asked.

"Perform a thoracic puncture and administer appropriate treatment based on the results. Pus can also be drained during the thoracic puncture. If the puncture and drainage aren’t very effective, then formal drainage will be needed," Su Wenhao said.

"Okay. Although you’ve all mastered thoracic puncture, this is a non-emergency case, so let’s transfer it to the Cardiothoracic Surgery department. But your judgment is accurate; it’s the same as I thought," Liu Banxia nodded.

DING! Diagnosis complete.

Gained 100 experience points and 20 proficiency points in Diagnostics.

Professional matters should be handed over to specialists. If the Cardiothoracic Surgery department were too busy, we could help out. But since they don’t have many patients right now, we should send cases like this their way. After all, it involves a thoracic puncture and possibly drainage. This patient probably didn’t get their pneumonia under control in time, and it suppurated after some delay at home. But it shouldn’t be too serious; otherwise, he wouldn’t seem so relaxed. I also have to think about that lady’s condition. Either the copper allergen is gone, or there’s another allergen. But if I can’t figure it out, it means we haven’t provided the patient with the most appropriate treatment.

As he was pondering, the alarm light in the main hall lit up. Seeing the displayed room number, Liu Banxia’s heart skipped a beat. It was indeed the ward where that lady was. Perhaps she’d gone into anaphylactic shock again.

"How’s the situation? Did she go into shock?" Liu Banxia asked as he rushed into the ward.

"She had another episode of respiratory distress just now. We administered one unit of adrenaline, and her condition has somewhat improved. However, the patient is now showing some asthma-like symptoms; we don’t know if it’s caused by an allergy," Xu Yino quickly reported.

"Sigh... Give her promethazine. We still need to find the allergen," Liu Banxia sighed.

"Doctor, what on earth is wrong with my wife? Can you even treat her?" the patient’s husband asked anxiously.

"We’re also trying to find a solution right now. Haven’t you seen I’ve assigned two doctors to her room?" Liu Banxia said patiently. "Our allergen screening showed a copper allergy, but after our careful examination, your wife wasn’t wearing any copper jewelry, nor has she come into contact with any copper since being admitted."

"Especially this time, she was just lying in the hospital bed. What could she have come into contact with? Absolutely nothing. Can you think again, did your wife show any other signs of discomfort during this period?"

The patient’s husband shook his head. "She’s been fine all along, just said she was a little tired from working overtime at the restaurant. But we need to save money. On the 30th of last month, I even helped out, and we earned an extra two hundred yuan."

He sighed. "Our two kids are starting school soon, and we need to give them money for living expenses. With her like this, I haven’t dared to tell them; I’m afraid they’ll worry."

"Try not to worry too much for now. We’re also trying to find the exact cause. Xu Yino, check the patient’s airway and see if there are signs of laryngeal edema," Liu Banxia said.

Xu Yino quickly checked.

"Teacher Liu, there’s slight edema," Xu Yino reported after checking.

"Monitor her constantly. If her condition worsens, intubate her immediately for airway protection," Liu Banxia said, frowning.

This was serious; the patient had already developed laryngeal edema. This indicated her allergic reaction was persisting. What on earth could be causing it? He considered the antiviral drugs but then ruled them out. It had been too long; if it were a drug allergy, she would have reacted much earlier. How could it wait until now? The patient’s immunity was currently low, which made the allergic reaction so dangerous. However, encephalitis wasn’t so easily cured. Throughout the entire treatment process, her immunity wouldn’t be strong, and she would always be at risk of another allergic attack. This was his biggest worry at the moment. He hoped the anti-allergy treatment could buy them some time—enough time for him to figure out what this mysterious allergic reaction was and what was truly going on.

When he went downstairs, Liu Banxia found a gap in Xu Hui’s consultations and updated him on the patient’s situation. Xu Hui was equally concerned.

"How about doing another allergen screening? Maybe the initial result was misleading, or perhaps something has changed now?" Xu Hui suggested.

"Although the chances are slim, let’s try it," Liu Banxia said after a moment’s thought, nodding.

"Teacher Liu," Su Wenhao rushed over, "the patient whose chest we punctured earlier—a large amount of pus was drained, and now he’s started coughing up blood. Doctor Liang is concerned and has sent him for a CT scan and bronchoscopy."

Liu Banxia frowned. "The X-ray showed some fluid, but it shouldn’t be this much. How could so much accumulate in such a short time?"

Su Wenhao nodded. "Doctor Liang thinks there might already be some degree of lung damage. We’ll have to see what the CT results show. If it comes to that, a thoracoscopy will be necessary."

"Heck, what’s with today? Are all the cases this bizarre?" Liu Banxia lamented. He turned to Xu Hui, "The infected area isn’t large, yet the pus is accumulating rapidly. Brother Hui, any idea what condition this could be? And there might also be some degree of lung injury."

"Well... aside from trauma or a foreign body in the lung, I can’t think of anything else," Xu Hui pondered. "Didn’t you diagnose a patient with a piece of plastic in their lung some time ago? That patient’s symptoms also progressed rapidly, didn’t they? No, wait, that one didn’t have empyema."

"Exactly. The onset for that case was about half a month," Liu Banxia said. "During auscultation, he lifted his shirt. There were no pressure marks or scars on his skin, no sign of any external trauma. And if it were caused by external trauma, he likely wouldn’t have been able to endure it at home for so long."

"We’ll just have to wait for the CT results then. Was there nothing abnormal on the chest film?" Xu Hui asked.

Liu Banxia shook his head. "Su and I looked at it together; we didn’t find any foreign bodies. Besides, even if there were a foreign body, how could it cause fluid to accumulate so rapidly? Could it be a living organism?"

"This case is getting interesting. Su, don’t forget to let me know the results when they’re out," Xu Hui remarked.

"I’m heading to the CT room now," Su Wenhao said before dashing off.

For doctors, complex cases, while challenging, also spark immense interest. It’s like solving a puzzle; routine problems don’t offer the same thrill. These two cases today had certainly stimulated Liu Banxia. Even though the first patient was a consult requested by Xu Hui, Liu Banxia now considered him his own patient. As for the second patient, he had reassured her husband earlier. Now that complications had arisen, had he missed something in his initial diagnosis?

He tried to recall the situation when the young man first came for treatment. He’d performed an auscultation and ordered an X-ray. Why had the illness progressed so quickly?

Just then, Liu Banxia’s phone rang. It was Xu Yino. He quickly answered, "Speak."

"Teacher Liu, the patient’s condition has improved after using promethazine. It really seems to be an allergic reaction," Xu Yino reported.

"That’s somewhat of a relief. When the patient is able to communicate, I’ll go up and see her. Let me know then," Liu Banxia instructed.

"Okay, Teacher Liu," Xu Yino replied before ending the call.

"Finally, some good news. At least the promethazine helped stabilize her for now. We’ll need to start anti-allergy treatment soon," Liu Banxia commented to Xu Hui.

"However, the task ahead is still challenging. What caused the allergy? Some substance within her body? Could it be parasites?"

"That’s unlikely," Xu Hui replied. "If it were parasites, the blood test should have shown something. If you’re still worried, should we order a cranial MRI just to be safe?"

Liu Banxia frowned. "Let’s wait. The patient’s family probably isn’t well off. Her husband is so anxious, possibly because of this reason too; they still have two kids waiting to return to university after the holidays."

"Sigh... they probably wanted a boy," Xu Hui commented. "Listening to their accent, they’re locals from Binhai. Back then, the fines for exceeding the birth limit here were quite steep."

"That’s why I’m hesitating. An MRI is expensive. We need to be cautious with any further imaging tests, considering their financial situation," Liu Banxia said with a wry smile.

"True," Xu Hui nodded. "We also tested her cerebrospinal fluid; there shouldn’t be any parasites in the brain. The chest CT also showed nothing. So, let’s focus on the allergy."

So, after all that discussion, they were back to the initial problem of the allergic reaction. This was the most frustrating part. They knew the screening indicated a copper allergy, yet the patient was reacting without any apparent contact with copper. This could only mean there was another undetected allergen, and finding it felt even harder than finding a needle in a haystack.

Just then, Liu Banxia’s phone rang again. It was Su Wenhao. "Speak."

"Teacher Liu, the patient suddenly developed a pneumothorax during the CT scan. Emergency measures were taken. Doctor Liang is now taking him to the operating room for a thoracoscopy," Su Wenhao quickly reported.

Liu Banxia pursed his lips. "You go with them and let us know the results as soon as possible."

"Okay," Su Wenhao affirmed and hung up.

The second patient’s case was also developing rapidly, which really troubled Liu Banxia. This also meant his initial diagnosis regarding the first patient—that pneumonia had led to suppuration—was likely incorrect.