Liu Banxia was currently full of aspirations, as he also needed to strive for his career. This career involved not only solid dical skills but also hospital managent abilities and responsibilities.
When it cos to money, I’m nowhere near Qiaoqiao. Only solid dical skills and positions can lift up a little. It’s indeed a helpless situation, probably one of the ’complications’ of having a rich girlfriend. It’s not like I can completely ignore these things. People might say you can regard money as dirt, but frankly, I hope for a bit more of that ’dirt’ these days.
"President Liu, do you have ti now? Could you co over for a consultation?" Zhang Xiao from Neurosurgery called out to him while Liu Banxia was still lost in pleasant thoughts.
"Alright, I’m on my way. What’s the situation?" Liu Banxia hurried over.
He had to be on call for such matters, as he was the chief resident. Moreover, his was a chief resident position with special responsibilities, requiring comprehensive involvent.
"Oh, Boss and Brother Xu are here too? Why didn’t I know about such a severe case?" He was startled to see Shi Lei and Xu Hui there.
"We just ca out of surgery. The situation is a bit complicated," Shi Lei said. "The patient, a car accident casualty, was brought in this morning when you weren’t here. He experienced cardiac arrest upon admission. Furthermore, during the physical examination, we found his pupillary response to be poor, so we called Dr. Zhang over, and we perford the surgery together.
"Currently, a splenectomy and external ventricular drainage have been perford to reduce intracranial pressure. The latest CT scan shows no hemorrhage, but there is edema.
"The patient is in our ICU, but his intracranial pressure is slowly increasing. So, we’re currently debating whether to proceed with a decompressive craniectomy or to continue with dical managent to control it.
"What’s making our decision difficult is that the patient’s latest blood test results show an extrely low platelet count, which would greatly increase the surgical risk."
Liu Banxia furrowed his brows. This isn’t an easy decision to make.
The primary functions of platelets are hemostasis and coagulation. If the platelet count is critically low, how can surgery be perford? He wouldn’t even et the criteria for preoperative assessnt. Forcing the surgery would likely result in massive hemorrhage for the patient.
However, given the patient’s current condition, if surgery isn’t perford to reduce intracranial pressure, the continually increasing pressure will also be fatal.
"Brother Zhang, how long before the edema could inflict damage to the brain?" Liu Banxia asked.
"We don’t have much ti. At most, five to six hours," said Zhang Xiao.
"And ’brain damage’ is just a broad term. Any cerebral edema compressing brain tissue can cause injury."
"This ans we don’t have much ti. I’m not sure if we should consult the patient’s family and take a gamble. My main concern is that the damage could be irreversible. Otherwise, even if he’s saved, his life would be ruined."
"Yes, that’s the most troubling part. But his platelet count is truly low. I suspect he might beco anemic within the next hour or two," Xu Hui added.
"During and after the surgery, we transfused a significant amount of plasma, packed red blood cells, and platelets. Could we induce a dically induced coma to allow his body to recover temporarily? After all, he just ca out of surgery and hasn’t recovered from it yet."
"Moreover, this approach might also lower intracranial pressure to so extent, buying us more ti, wouldn’t it? At the very least, we might be able to determine the cause of the thrombocytopenia."
Zhang Xiao nodded. "I agree with this, but we would have to set a ti limit. We simply cannot afford to wait indefinitely. Any further delay could lead to brain herniation, potentially resulting in a persistent vegetative state or death."
"Boss, what do you think?" Liu Banxia looked at Shi Lei.
Shi Lei shook his head. "This situation is too complicated, and we don’t have much ti. Identifying the cause will take ti, but the patient’s intracranial pressure won’t afford us that much ti."
"How about this: first, we need to thoroughly apprise the patient’s family of the situation and help them understand it fully. The dical advice we can offer is to first induce a therapeutic coma to stabilize the patient’s vital signs," Liu Banxia suggested.
"Simultaneously, we should all carefully consider what’s causing the patient’s thrombocytopenia. Once we determine that, we can decide on a detailed treatnt plan."
"Brother Zhang, you’ll have to work hard to continuously monitor this patient’s intracranial pressure. For the tiline, let’s schedule another blood test in an hour and a half. We’ll assess the situation then and discuss further. How does that sound?"
"Although conservative treatnt isn’t entirely without risk, it’s at least one of the viable options we can currently consider. If the patient’s platelet count cannot be raised, he truly might not be able to achieve hemostasis during surgery and might not make it off the operating table."
"Alright, don’t worry. I will continuously monitor the patient’s intracranial pressure. This patient is currently one of the most critical cases in the ICU, and they are also giving him close attention," Zhang Xiao replied.
"President Liu, you’ll have to rack your brains. I’ve been thinking for a long ti but haven’t figured it out yet," Xu Hui said with a wry smile.
Liu Banxia grinned bitterly. I never expected Xu Hui to pass the buck to . Is it perhaps because of my impressive performances lately?
"How about this: you’ve all been discussing for a while, and your minds must be cluttered. Let’s each go think about it based on the current diagnostic information. We’ll regroup after the next blood test results co in. Perhaps we’ll have a clearer line of thought by then," Liu Banxia said.
The three of them nodded in agreent. For now, this was the only option.
"Boss, did Xu Hui and Zhang Xiao start to argue just now?" Liu Banxia asked softly after they stepped out.
Shi Lei nodded. "Otherwise, I wouldn’t have suggested Zhang Xiao call you. Right now, only you or the director can diate. I can’t very well go to the director, can I?"
"Ah... it’s normal to have disagreents. It won’t affect our cooperation in the future, right?" Liu Banxia asked worriedly.
"Don’t worry, they still possess that level of professional ethics. It’s quite normal to have disagreents over diagnostic directions in a case. Haven’t you experienced this before? It’s always about the case, not personal. Everything we do is for the sake of the patient," Shi Lei said.
"But we really do need to address this urgently; otherwise, this patient is truly in grave danger. I’ll go communicate with the family first. After all, I’m relatively neutral, so it wouldn’t be appropriate for either of them to go."
Liu Banxia nodded, feeling a surge of anxiety himself.
They were all experienced physicians. The fact that Zhang Xiao and Xu Hui could have such a dispute demonstrated just how complex and critical the patient’s condition truly was.
One might even say his recent decision was a gamble. Just as Brother Zhang said, the impact of intracranial pressure on the brain can only be roughly predicted.
In principle, it should always be dealt with as quickly as possible.
"President Liu, what’s the matter?" Wang Chao asked curiously.
"I’m mulling over a case. The patient’s platelet count is decreasing, and his intracranial pressure is rising. It’s the car accident patient Shi Lei and the others admitted while I was in Orthopedics," Liu Banxia said.
"If more patients co in, unless it’s extrely urgent or a major accident, don’t call for now. I need to focus on this patient’s case."
Wang Chao nodded. "No wonder they gathered together after the surgery. I only knew the patient was sent to the ICU; I didn’t expect it to be this severe."
"So, it’s quite a headache. I’m going to take a look now," Liu Banxia said before ducking into his office.
There are so many possible causes for thrombocytopenia. The most common are platelet production disorders, such as aplastic anemia, acute leukemia, or acute radiation sickness. Then there’s increased platelet destruction, from conditions like primary immune thrombocytopenic purpura, hypersplenism, disseminated intravascular coagulation (DIC), or hereditary thrombocytopenia. To pinpoint the cause, I’d have to investigate step by step. But these investigations aren’t straightforward. It’s not like a blood test will make everything crystal clear. More often, blood tests only show the results; then, doctors need to use their knowledge to work backward and find the reason for those results. Considering the known factors, I can rule out a few things. For example, hypersplenism is out since the spleen has been removed. Hereditary thrombocytopenia is also unlikely. But many other possibilities remain. My primary suspicion now is DIC. Major surgery or trauma is one of the underlying conditions that can trigger this complication. It’s highly probable that the car accident and the recent surgery caused DIC in this patient, leading to the low platelet count. However, so aspects don’t quite fit this diagnosis. According to the case notes from the ICU, there’s no visible bleeding from the wounds. Bleeding is a fundantal symptom during the active phase of DIC. The patient’s platelet count, while low, isn’t catastrophically so. And it seems to be decreasing gradually. His current blood tests show normal coagulation function. The crucial issue is ti. If we had enough ti, we could ticulously rule out causes through various tests. But his intracranial pressure is constantly rising! That will definitely cause brain damage!
After pondering in his office for a while, Liu Banxia slapped his forehead, an idea striking him, and then he rushed out like the wind.
Shi Lei, looking anxious, hurried over. "I was just looking for you! Did the patient’s family agree to an urgent decompressive surgery?"
"Boss, do you think it could be thrombotic thrombocytopenic purpura (TTP)?" Liu Banxia said.
"You an TTP? Is that possible?" Shi Lei wrinkled his brow and asked in return.
"Possible or not, let’s go straight to the ICU. Get Brother Xu and Zhang Xiao too," Liu Banxia said.
"If that’s truly the case, performing surgery would be a death sentence for the patient. We can’t delay any longer. Let’s go take a look imdiately."
Although Shi Lei was still a little unsure, he nodded. After all, for Liu Banxia to suggest it, he must have so basis.
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