"What’s the situation? Explain clearly." Liu Banxia asked after Xu Yino completed the auscultation.
"The complete blood count shows slightly elevated white blood cells, and there’s so inflammation in both lungs. Levofloxacin sodium chloride injection was administered. About fifteen minutes into the infusion, the patient experienced sudden dyspnea and broke out in a cold sweat," Xu Yino hurriedly stated.
"After I removed the needle, auscultation revealed a friction rub. Given the patient’s current condition, an allergic drug reaction can be ruled out. It’s assessed as a pulmonary embolism."
"Are you sure?" Liu Banxia asked, staring at Xu Yino.
"I am. Well... based on the current situation, yes," Xu Yino replied.
"How do we confirm the diagnosis? Is ergency thrombolytic therapy needed?" Liu Banxia pressed.
"A chest CT, echocardiogram, blood gas analysis, and lung ventilation scan. Thrombolysis isn’t deed necessary at this ti. Since the patient has diabetes, further confirmation is needed," Xu Yino replied.
Liu Banxia nodded. "Go on. Keep a close eye on the patient’s vital signs and be prepared for ergency resuscitation."
Everyone looked at Xu Yino with admiration. Xu Yino’s handling of the situation had been very thodical and composed in the face of an ergency, truly deserving full marks.
Pulmonary embolism was a dangerous condition frequently encountered in ergency dicine, especially in patients with fractures or those who were postoperative. Liu Banxia and his team had dealt with such rescues many tis before.
This was a perilous condition. Occlusion of a small blood vessel might not be critical, but if a major vessel was blocked, there was often no ti for rescue.
"This feels sowhat familiar, doesn’t it? It seems like the director handled you this way back then too, right?" Shi Lei asked.
"I just took the opportunity to test him. But this patient was initially diagnosed with only mild pneumonia. How did he develop an embolism?" Liu Banxia frowned and said.
"Look at this chest X-ray. The inflammation isn’t extensive, is it? This isn’t myasthenia gravis. Could there be other underlying conditions?"
"Let’s see after the CT scan. There are so many potential causes for an embolism; it’s hard to say where this thrombus might have originated," Shi Lei said.
Liu Banxia nodded. It was true that many conditions were difficult to diagnose effectively before they manifested. The causes of pulmonary embolism were varied; it could well be a thrombus from a blood vessel elsewhere that had dislodged and caused the problem.
The patient was no longer young, so it was quite common for a thrombus to dislodge from sowhere in his cardiovascular system.
However, even if they could make a definitive diagnosis at that mont, they still needed instruntal confirmation. In non-ergency situations, this was the standard procedure.
"These current interns are performing really well. You’ll have to put in more effort for the next batch, or it’ll be tough," Shi Lei said.
"Sigh... you heard what the director said, didn’t you? I’m a bit worried now. But Old Xu from Jinshui District Hospital ntioned he could help introduce to so people at the dical college," Liu Banxia said.
"Not being an alumnus of Binhai dical College is my Achilles’ heel, isn’t it? Can’t you put in so effort? Help scout for so promising candidates too."
Shi Lei shook his head decisively. "I’ve been out of that loop for too long. Let the interns help; their connections are likely stronger. At least you won’t have to go about it blindly."
"Also, you could apply to the school to hold a recruitnt drive. Didn’t the last one you did at the Experintal Middle School go very well? Just do that again."
"Why can’t you think of sothing constructive? Sigh... go find a place to rest. You need to get up early tomorrow and handle that blind date properly," Liu Banxia said.
Shi Lei started to fret. He wouldn’t be this conflicted even when facing an ergency patient. But the thought of the blind date tomorrow made it feel like an incredibly difficult task.
Just then, Liu Banxia’s phone rang again. He answered, and after listening for a few monts, his expression changed drastically. "Wait for , I’ll be right there."
"What’s wrong?" Shi Lei asked.
"That patient just now had a cerebral infarction during the chest CT. Things seem to be getting complicated," Liu Banxia said quickly before rushing towards the CT room.
The patient’s condition had worsened. It was highly possible that a cerebral thrombus had dislodged and traveled to his lungs.
"What’s the situation?" Liu Banxia asked upon entering the CT room.
"During the chest CT, the patient reported numbness in his face and hand, and one side of his body beca sowhat unresponsive. Teacher Liu, can we proceed with thrombolytic therapy imdiately?" Xu Yino asked.
"Let’s wait for the head CT results to assess the embolism. Is the lung scan done?" Liu Banxia asked.
"The lung scan hasn’t been done yet. The patient started feeling unwell just as he was moved into the scanner. However, the ultrasound is complete, and it has confird pulmonary embolism; the main pulmonary artery isn’t blocked," Xu Yino said.
"However, one thing is particularly noteworthy: the patient has pulmonary emboli in three locations, not just one. Now, depending on the intracranial embolism, I can’t shake the feeling that this patient’s case is sowhat unusual."
Liu Banxia nodded. "It is indeed strange. Let’s see the results of the head CT."
"Simultaneous pulmonary and cerebral embolisms are indeed rare," Wu Bo comnted from the side.
"If it were a single pulmonary embolism, it might be understandable—perhaps a dislodged clot from elsewhere. But in this situation, I think we should consider performing an angiography."
"Yes, but we need to consider the patient’s overall condition. His family hasn’t arrived yet, and he has diabetes, which makes things more complicated," Liu Banxia said.
Angiography is an invasive procedure. For diabetic patients, any invasive examination must be approached with extre caution.
After so thought, Liu Banxia called Peng Bo from Neurology and Xu Guosheng from Cardiology. They had to be extrely cautious with this patient; pulmonary embolism combined with cerebral infarction was no laughing matter.
"Good heavens, there are... four intracranial emboli, right? Although they aren’t very long, this is still quite serious," Wu Bo said with so surprise when the head CT results ca in.
"The patient ntioned having a headache upon admission. Perhaps these emboli are the cause. What do you two think? Is surgical intervention required?" Liu Banxia asked.
"I believe thrombolysis should be sufficient. However, the simultaneous occurrence of multiple pulmonary emboli and multiple cerebral infarctions suggests there might be other underlying problems," Xu Guosheng from Cardiology advised.
"The patient is at an age prone to illness, but judging by his physique, he doesn’t appear to be soone who regularly indulges in rich foods. You ntioned he has diabetes; what about his blood pressure?"
"Teacher Xu, his blood pressure was checked and it’s normal. He only has diabetes, a history of over four years, and it’s well-controlled with dication," Xu Yino quickly explained.
"Let’s proceed with thrombolysis first to prevent further deterioration. Fortunately, the emboli aren’t very large, but such a presentation is indeed uncommon," Peng Bo from Neurology said.
"Xu Yino, contact the patient’s family again and admit him directly. His condition is complex. He needs constant bedside monitoring after the infusion. Then, draw blood for a full biochemical panel," Liu Banxia instructed.
Xu Yino nodded and quickly went to make the arrangents.
"The patient initially presented with a cold, likely an upper respiratory tract infection, and mild pneumonia," Liu Banxia mused. "Now, he has multiple embolisms. Did all these emboli detach from vessel walls simultaneously? So quickly, so coincidentally? As if they planned it?"
"For now, we can only observe the effects of the thrombolysis and wait for the biochemistry results," Peng Bo said.
"Alright, I’ll discuss this with Brother Hui later. I’m not very knowledgeable about thrombogenesis, and I find this patient’s case quite peculiar," Liu Banxia nodded.
Ding! Task Issued: Multiple Embolisms
Open Task: A patient presenting with cold symptoms has suddenly developed multiple embolisms. The host is required to conduct further diagnosis to determine the etiology. Task rewards will be issued based on the diagnostic findings.
"I agree, but I’m more inclined to believe that so emboli ford and dislodged much earlier. They just didn’t completely occlude the vessels, which is why the symptoms weren’t so pronounced," Xu Guosheng said.
"That’s a plausible scenario, but for now, it’s just a hypothesis. Let’s wait for the biochemistry results; perhaps his lipid levels are high. High cholesterol isn’t unheard of even in slender individuals; diet plays a major role. Moreover, the patient has diabetes, and his dication might be masking underlying hypertension."
"Alright, I’ll inform you both once the results are available," Liu Banxia nodded with a smile. "Performing surgery wouldn’t be an issue for , but I’m not adept at such detailed pathological analysis. I’ll need your expertise on this. I’ll go bother Brother Hui about it later too."
Both n chuckled. They appreciated Liu Banxia’s unpretentious nature; otherwise, they wouldn’t share such a good rapport.
Liu Banxia was the rising star of the Ergency Center; he had successfully diagnosed many complex cases and perford nurous complicated surgeries. Yet, he candidly admitted his limitations in certain in-depth areas, a rare trait. Why else would he say he was going to "tornt" Xu Hui? It was because he genuinely needed Xu Hui’s help with the analysis.
Back in the Ergency Center, Liu Banxia went straight to Xu Hui’s office and pulled up the patient’s head CT images.
"What’s up?" Xu Hui asked.
"A consultation," Liu Banxia replied. "The patient has multiple cerebral infarctions and multiple pulmonary embolisms. We need to figure out how these emboli ford. His history includes diabetes. He presented with cold symptoms: coughing, runny nose, fever, and headache. His complete blood count showed slightly elevated white cells, and the biochemistry panel was just run."
"No wonder I noticed so inflammation in his sinuses on the scan. You’ve started thrombolytic therapy, right?" Xu Hui asked.
Liu Banxia nodded. "Yes, it’s underway. I just find this patient’s situation highly unusual. The sinusitis is likely secondary to the upper respiratory tract infection."
Although only a small, sowhat unclear portion of the sinuses was visible on the scan, Liu Banxia and the others had noticed it. It was to be expected; with such a severe runny nose, it would have been surprising if there were no signs of sinusitis.
However, Xu Hui was also at a loss for now. With insufficient data, he too could only wait for more results.
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