"Liu Yiqing, looking at this chest X-ray, what are your thoughts?" Liu Banxia asked after the patient left.
"I also feel that his pneumonia isn’t that simple, especially the diffuse inflammation in the right lung," Liu Yiqing said.
"Yes, the current presentation of lung inflammation is too disparate. So mild on the left, yet so severe on the right. It’s only been three days, right? He must have been taking antibiotics along with cold dications at ho," Liu Banxia said.
"It could very well be a tricky pathogen. Notify the lab for a blood culture. When the patient returns, remind to take a sputum culture as well."
"Teacher Liu, is it that serious?" Liu Yiqing asked curiously.
"Better safe than sorry. Pneumonia caused by a normal cold is rarely this severe; at least, I’ve never seen it," Liu Banxia said.
"How is the child from yesterday? I asked a nurse, and she said the parents were much more emotionally stable after your talk. Apparently, you’re excellent at communicating with patients’ families."
"Teacher Liu, aren’t you... aren’t you going to ask anything?" Liu Yiqing hesitated for a mont before asking.
"What should I ask? I don’t really have anything I need to ask. Oh, wait, I do. Have you made a decision? Will you be staying at the Second Hospital in the future? I haven’t received your commitnts yet, and it’s making anxious," Liu Banxia asked.
"Um... Teacher Liu, I want to stay at the Second Hospital. If I stay, will I be able to continue learning from you?" Liu Yiqing asked.
Liu Banxia nodded. "I’m definitely anchored to the Ergency Center, but ’teaching’ isn’t quite the right word. Although we call it education, it’s more of a discussion and exchange of dical knowledge."
"You all have strong foundations; you just have less experience than I do. You’re putting a lot of pressure on Wang Chao, haven’t you seen how proactive he’s beco recently?"
"As long as you can focus and minimize external distractions, I believe your future achievents will be significant. You have the brains, the skills, and the right attitude. You’re all natural-born surgeons."
"Then I’ll stay. I want to learn properly," Liu Yiqing said.
"Success! I’ve managed to sway another die-hard subordinate," Liu Banxia said, making a victory sign.
Liu Yiqing chuckled, then her expression turned serious again. "Teacher Liu..."
Liu Banxia waved his hand. "The X-rays for those patients are starting to co back. You handle the consultations; I’ll supervise."
"Oh..." Liu Yiqing responded, obediently sitting in the spot Liu Banxia had vacated.
They had just finished a series of consultations, and now the X-ray results would start coming in. The symptoms of these next few patients weren’t very severe, so it was a good opportunity for Liu Yiqing.
Liu Banxia could sowhat guess what Liu Yiqing wanted to say; it probably had sothing to do with yesterday’s events. But it was a private matter, and he would only listen when she was ready to talk about it.
Girls tend to be emotional. Even though he was only a little older than her, in the minds of these interns, he was nonetheless a proper teacher.
Indeed, the conditions of the next few patients who returned weren’t severe, and Liu Yiqing handled them effortlessly. With Liu Banxia supervising, the prescriptions she wrote were appropriate.
After sending off the last patient, Liu Banxia gave her a thumbs-up; a little encouragent was still necessary.
"President Liu, you should go eat first," Xu Hui said, walking in from outside.
"Liu Yiqing, let them go eat first. I need to wait for the CT results of that last patient. Brother Hui, don’t rush off. Stay and consult on this case with ," Liu Banxia said.
"Is the situation very serious?" Xu Hui asked.
Liu Banxia nodded. "The chest X-ray is here, and his temperature is a bit high."
Xu Hui leaned over to look at the chest X-ray Liu Banxia had reinserted into the light box and frowned as well. "The infection is indeed quite serious. Call when his results co back; I still have two patients to see."
Liu Banxia stepped out of the consultation room with Xu Hui to check if anything outside needed his attention. Fortunately, there were no complex situations.
It had to be said that the staff in the Ergency Center were well-seasoned by now. Barring major ergencies or severe staff shortages, they generally wouldn’t call for him. This was a far cry from when the Ergency Center was first established. Back then, he was constantly being called because everyone lacked experience and confidence.
After waiting a little longer, the patient returned. Liu Banxia frowned; the patient’s symptoms seed to have worsened. His breathing was rapid, indicating increased respiratory distress.
"Liu Yiqing, retake his temperature. I’ll auscultate him," Liu Banxia said directly before the patient could speak.
The patient was startled for a mont but still sat on the examination bed.
"Teacher Liu, his temperature has risen to 39.4 degrees Celsius," Liu Yiqing’s voice rose slightly after checking with the temporal thermoter.
Liu Banxia, who was auscultating, also frowned but said nothing. Instead, he put the patient’s CT scan onto the light box.
The CT scan provided a clearer picture, causing Liu Banxia’s frown to deepen. He then took out the patient’s earlier chest X-ray and placed it on the light box as well.
It was evident that in just one morning, the patient’s lung infection had significantly worsened.
"Your pneumonia is quite serious. We need to admit you to the hospital," Liu Banxia said to the patient.
"Can you give so dicine for the fever? I really can’t stand it anymore; my head hurts," the patient said.
"Liu Yiqing, get a sputum culture and run another coagulation test. Tell them to expedite it, and call Dr. Xu Hui over," Liu Banxia instructed.
"Doctor, is my condition very serious?" the patient asked, sensing that sothing was wrong.
Liu Banxia nodded. "Not just very serious, it’s extrely serious. By the way, what has your urine output been like since yesterday?"
"With the fever, I haven’t been urinating much," the patient said with a bitter smile.
Liu Banxia pinched the space between his eyebrows; the patient’s words further confird his suspicions.
"President Liu, are the scans ready?" Xu Hui walked over at that mont.
"The one on the left is the CT scan taken just now; the one on the right is this morning’s chest X-ray. The patient’s temperature is 39.4 degrees Celsius, blood pressure is 55/100 mmHg. I didn’t asure his heart rate precisely, but it’s likely over 110 beats per minute. He also has oliguria," Liu Banxia reported gravely.
"Anything else?" Xu Hui asked.
"We’ve also done blood and sputum cultures," Liu Banxia said.
"I agree with your assessnt. Let’s send him to the ICU imdiately," Xu Hui nodded.
"What? Doctor, what’s wrong with ?" The patient beca agitated, his breathing growing more labored.
"Although the test results aren’t back yet, we suspect your pneumonia has led to sepsis," Liu Banxia said.
"A regular ward can’t provide the level of care you need, and you should contact your family. I’m not trying to scare you; didn’t you see how rapidly your condition is progressing?"
"The four cardinal signs of sepsis are high fever, tachycardia, tachypnea, and leukocytosis. If we don’t intervene promptly, it can progress to septic shock and organ failure."
"Your heart sounds aren’t good, and your blood pressure is very low. It’s possible your heart has already been affected. I’m not trying to frighten you, but for your own safety, it’s best to go directly to the ICU."
"I... I need to contact my family first," the patient said nervously, his hand holding the phone trembling.
Liu Banxia raised his arm to wipe his forehead; the urgency of the situation had caused him to break out in a sweat.
Sepsis is truly terrifying, not only because it’s easily confused with other illnesses at its onset but also because it progresses rapidly and has a very high mortality rate.
Given the patient’s current state, it appeared he had already progressed to severe sepsis, the second stage. He was already exhibiting hypotension, but Liu Banxia hadn’t dared to explain the full extent of this to the patient yet.
The next stage would be as he had described: shock, multi-organ failure, and death.
They didn’t have much ti. Since the sepsis stemd from a lung infection, treatnt required identifying the exact causative pathogen and its drug sensitivities to enable targeted therapy.
A vast number of pathogens can trigger sepsis, including bacteria, fungi, viruses, and parasites. The most common primary infections leading to it are pneumonia, peritonitis, cholangitis, and cellulitis, among others.
That’s why ergency departnts are so vigilant with cases of acute abdominal pain—they fear the potential complication of peritonitis, which can trigger a cascade of further illnesses.
After a good five minutes, the patient finally finished speaking with his family. The patient, now utterly drained of strength, sagged onto the examination bed.
This was the fear of a severe, unknown illness. Even without a detailed explanation from Liu Banxia and the others, who would think that soone being sent to the ICU was suffering from a minor ailnt?
"Sepsis?" Su Hongbo asked with a frown after the patient was transferred to the ICU.
He was an ICU doctor, and these were the kind of patients he most feared. Such patients often made you feel powerless; if the specific infecting pathogen couldn’t be identified, you could only use broad-spectrum antibiotics, often with limited success.
"I’ve already asked the lab to expedite the tests. Hopefully, he can last until tomorrow afternoon or evening," Liu Banxia said.
"We also have the patient’s consent. A ventilator and ECMO can be used if needed. His family is on their way."
Su Hongbo nodded. "Alright."
This was an instruction for all-out resuscitation. With this directive, Su Hongbo felt a bit more assured. Based on his experience, the patient might need to be put on ECMO by tonight. His breathing was already so bad; how much longer could he hold on?
This highlighted the terrifying nature of sepsis. It’s easily misdiagnosed, often mistaken for a common cold. By the ti it’s correctly identified, the disease has typically progressed significantly.
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