"Liang Xiaolin, protect her airway and tongue! Xu Dan, one unit of lorazepam!" Liu Banxia, reacting quickly, caught Han Miao, laid her on the hospital bed, and turned her onto her side.
Both Teacher Song and Xiao Yue were scared witless. Han Miao’s seizure was much more intense than the one at school; this ti, Han Miao even started kicking her legs.
Upon hearing the command, Xu Dan rushed to find the dication, while Liang Xiaolin moved to Han Miao’s head.
"Dr. Liu, let help." Seeing Liu Banxia only holding Han Miao’s shoulders, Teacher Song grew anxious.
"Don’t move! You can’t hold down her legs or arms right now; she could dislocate a joint. Let’s observe first and see if the sedative takes effect," Liu Banxia quickly intervened.
Typically, when encountering soone having a seizure, people try to restrain their limbs to prevent injury. However, this can sotis cause more harm.
During an epileptic seizure, movents are involuntary, aning the force exerted is uncontrollable. While restraining the patient prevents them from hitting people or objects, they can very well injure themselves.
The most crucial steps are to protect the airway and tongue. So patients clench their teeth so hard they bite their tongues, sotis even severing them. Others may foam at the mouth, and this foam can cause suffocation.
After nearly a minute, Han Miao’s body finally stilled. Although she regained consciousness, she was utterly exhausted.
"Dr. Liang, schedule a head CT scan with contrast. Her seizure symptoms strongly resembled those of a cerebral hemorrhage," Liu Banxia said.
"But Dr. Liu, she didn’t hit her head," Qiu Mingyuan interjected.
"We can’t be sure yet. Let’s do the scan first and see," Liu Banxia replied, frowning.
In truth, he also harbored doubts. If Han Miao had a cerebral hemorrhage, the earlier plain CT scan should have detected it. The only possibility was delayed hemorrhage, perhaps from a blow to the head during her first seizure that her classmates hadn’t noticed.
He now ruled out his initial diagnosis. If it were primary epilepsy, the reactions wouldn’t be this severe, and the seizures wouldn’t occur this frequently.
"Dr. Liu, should we call for a consultation now?" Xiao Yue asked.
"Not yet. We still can’t be sure if the cause is neurological," Liu Banxia stated.
If he hadn’t handled Grandpa Cao’s case, he might have imdiately contacted neurosurgery or neurology. But now, as a responsible chief resident, he couldn’t act rashly on incomplete information. A multi-departnt consultation was only justified when indications were clear or when they truly couldn’t pinpoint the cause.
Xiao Yue glanced at him but said nothing more; she didn’t yet understand these considerations.
"Dr. Liu, the blood test results are in," Shen Lin announced a short while later, handing them over.
Liu Banxia took the report and scanned it, his brow furrowing slightly. All the values appeared normal. Just monts ago, he had considered an infection as a possible cause, but the white blood cell count was within the normal range.
Now, all he could do was hope for the results of the contrast CT scan.
"Teacher Song, I think it’s best to contact her parents now. Her condition is unclear, and if the seizures continue, it could beco dangerous," Liu Banxia advised.
Teacher Song nodded. "I’ve already contacted her father. He’s catching the earliest flight here. Han Miao’s grandmother has high blood pressure, so her father said not to tell her yet."
"Alright. In any case, you’re essentially her temporary guardian. Let’s hope it’s nothing too serious with the child. Today’s situation is quite tricky," Liu Banxia said.
"Don’t worry, Teacher Song. Dr. Liu is very skilled. My dad just blinked his eyes, and Dr. Liu diagnosed a blood clot in his brain," Qiu Mingyuan offered comfortingly.
"Sigh... It’s almost noon. You two should go get sothing to eat. I’ll wait here," Teacher Song suggested.
"Teacher Song, let’s all wait for Miao Miao’s results together," Xiao Yue said.
This ti, the results ca quickly. Wu Bo from Radiology called Liu Banxia directly to report that the scan still showed no abnormalities.
Liu Banxia was now genuinely troubled. He felt he was out of options and had to call for a consultation.
"Everyone, I’m at my wit’s end. Blood tests, urine tests, and both plain and contrast CT scans are all normal. Her body temperature and physical exam are also normal. She reports no headache or chest tightness, and there’s no relevant family dical history. Can any of you offer so insights? She’s had two seizures so far," Liu Banxia said.
"President Liu, could it be ningitis?" Zhang Xiao, an attending from Neurosurgery, suggested.
"I was also considering ningitis or endocarditis," Peng Bo, an attending from Neurology, added. "Both can cause seizures. But if either condition had progressed enough to cause seizures, there would definitely be other external symptoms."
The fact that all tests returned normal was, in itself, highly unusual. The seizures were undeniably real. If they were only occasional or very infrequent, they might be classified as primary epilepsy.
"How about a lumbar puncture? Or an X-ray?" Wang Huan proposed.
"Let’s think this through more carefully. A lumbar puncture is an invasive procedure, and the child’s guardian isn’t here. An X-ray is feasible. I’m debating whether to order a chest and abdon CT, but I’m concerned about the high cost and how difficult it would be to explain to her parents when they arrive," Liu Banxia said with a wry smile.
The others looked equally troubled. This was indeed a problem.
Because the child’s symptoms were so ambiguous, too many instruntal examinations could easily upset the parents and lead to conflict.
"Dr. Liu, you were the first to see her. What’s your gut feeling? Sotis, to put it bluntly, doctors rely on educated guesses based on experience, and first impressions are often crucial," Wei Yuan asked.
"My initial thought was primary epilepsy, but I ruled that out after her second seizure. Then, based on her seizure symptoms, I suspected a cerebral hemorrhage, but the contrast CT scan still showed nothing abnormal," Liu Banxia admitted.
"Dr. Liu, Han Miao is seizing again!" Xu Dan rushed in, shouting.
Without hesitation, Liu Banxia bolted out of the room.
"Dr. Liu, we’ve given one unit of lorazepam, but she hasn’t stabilized! Her vital signs are declining," Liang Xiaolin reported as Liu Banxia arrived.
"Bring the defibrillator, prevent ventricular fibrillation!" Liu Banxia commanded.
BEEP—
At that mont, the monitor emitted a long, continuous tone.
"This is bad, her heart has stopped! Liang Xiaolin, protect the airway! I’ll start CPR. One unit of epinephrine, stat!" Liu Banxia exclaid, imdiately beginning chest compressions.
"Defibrillator’s here!" Zhou Li shouted.
"Charge to 200 joules!" Liu Banxia ordered, continuing compressions.
"Charged!"
"Clear!"
THUMP!
"No response, her heart has been stopped for 17 seconds."
"Three hundred joules!"
"Charged!"
"Clear!"
THUMP!
"We have a heartbeat! She’s back in sinus rhythm, blood pressure is rising!" Liang Xiaolin cried out, a mix of relief and excitent in her voice.
Liu Banxia handed the defibrillator to Zhou Li, nearly collapsing to the ground. He had never imagined that what seed like a simple case of epilepsy could turn so life-threatening.
"Dr. Liu, we can’t delay any longer. Whatever tests are needed, let’s do them all," Zhang Xiao urged.
"Do you think it could be a tiny cerebral aneurysm or a ruptured vascular malformation, causing a slow bleed that both the plain and contrast CT scans missed?" Liu Banxia asked.
"Dr. Liu, while that’s possible, isn’t the probability extrely low? Did the patient ntion any headaches?" Zhang Xiao asked, frowning.
"No. However, the patient fell while jogging the day before yesterday and had a mild seizure that night," Liu Banxia replied.
"Yesterday, she was fine. But today, her seizures have been very severe. This is the third one, and it even led to cardiac arrest."
"We’ve ruled out many possibilities, so we must return to the epilepsy itself. My theory is this: the fall caused her blood pressure to spike, rupturing a tiny aneurysm. The initial bleeding was minimal and likely went unnoticed."
"After a day of rest, the stress from her exams might have caused the vessel—which had possibly already stopped bleeding—to hemorrhage again. The seizures then exacerbated the bleeding."
"But our CT scans didn’t detect anything?" Peng Bo from Neurology questioned.
"It’s likely because the blood vessels are too small to be detected by CT. Since we have to run more tests anyway, how about we do a cerebral angiography?" Liu Banxia proposed.
"We’ve ruled out many ’impossibilities.’ Shouldn’t we now consider the most probable cause? Even if it’s microvascular bleeding, if the volu increases, it will beco very difficult to manage."
The others exchanged glances. Although Liu Banxia’s reasoning seed to be based solely on his speculation about an aneurysm, given the current dire circumstances, it was a viable option.
The child was in critical condition. If they did nothing, the next seizure could very well be fatal.
"’Okay, it’s settled then. We’ll do a cerebral angiography. I’ll go with you,’ Liu Banxia decided.
That settled it. The patient was from the Ergency Departnt, and as its chief resident, Liu Banxia had the authority to make this call.
Cerebral angiography differs significantly from a CT angiogram. In the forr, a contrast agent is injected directly into the blood vessels. Because X-rays cannot penetrate this agent, angiography allows for a clearer diagnosis of vascular lesions.
However, cerebral angiography is an invasive procedure and carries risks, including severe allergic reactions that can be life-threatening. Liu Banxia’s decision was bold, made entirely for the patient’s sake.
Zhang Xiao and the others didn’t leave; they followed him into the procedure room.
As the contrast agent was injected, an image slowly ford on the screen. In the upper-right quadrant, a small, glaring spot appeared.
「DING! Xu Dan’s requested task was completed.」
「Received 300 experience points, Diagnostics skill proficiency 500 points.」
「Task rating: Perfect. Reward: 1,000 experience points, Diagnostics skill proficiency 500 points, and 10 Glory Points.」
Liu Banxia let out a long sigh of relief. "To think it actually happened, even though the chances were slim. Dr. Zhang, she’s in your hands now; this is a job for neurosurgery."
Zhang Xiao gave a thumbs up. "Impressive. I’ll go prepare the operating room."
Zhang Xiao’s words echoed everyone’s sentints. Whatever Liu Banxia’s reasons for pursuing this line of thought, he had, at the very least, saved the child’s life.
User Comments
0 comments from readers