(Thanks to Empty Loneliness Cold 671112 for the support ticket)
Although this patient wasn't admitted directly to the ICU, he was definitely a very important patient in the ergency center who needed constant monitoring.
The latest blood test results showed mild kidney failure. However, the fecal test ca back negative, with no signs of parasitic eggs.
"Damn, signs of multi-organ involvent, as expected," muttered Liu Banxia.
"Teacher Liu, should we screen for heavy tals and toxins?" Xu Yino asked.
"We can forgo heavy tals for now. Even though heavy tal poisoning can present with high fever, it often leads to hallucinations as well. Our patient here only exhibits so personality changes and isn't suffering from hallucinations," Liu Banxia said.
"As for toxin screening, let's hold off on that too. If we were to do it, we'd need to draw more blood. Currently, we need to manage his electrolytes to prevent further damage to his kidneys and other organs."
"Teacher Liu, the MRI results are negative; his brain and cervical spine are fine. The cerebrospinal fluid is being tested. It looks like ningitis," Miao Rui said as he rushed back, pushing the patient.
"Send him straight to the ward, and we'll cool him down with a body wipe there. I'll go with you. Brother Wei, please keep an eye on things down here," Liu Banxia said.
Wei Yuan nodded. "Go ahead. Wang Chao should be back soon; he just called ."
Liu Banxia gave an OK gesture and followed them upstairs.
Once in the ward, they had to be cautious while transferring the patient to the bed, considering he had just undergone a lumbar puncture and was receiving anticoagulant thrombolytic treatnt.
"How does your neck feel now?" Liu Banxia asked after they had moved the patient.
"A bit stiff," the patient replied.
"Next, I need to explain so things to you. Please listen calmly," Liu Banxia said.
"According to your latest blood test results, your kidneys are showing signs of mild failure. Therefore, we'll make so adjustnts to your treatnt and administer so dication."
"Moreover, your current condition could potentially lead to multiple organ failure, which is a far more severe issue than the stiffness in your neck. Do you understand?"
"I understand," the patient said.
"Good. I've explained what you need to know. Now we move on to the treatnt phase. To make you more comfortable, we will give you an alcohol sponge bath to cool you down," Liu Banxia said.
"Su Wenhao, get ready. The rest of you, co outside with . You too," he added, looking at the patient's girlfriend, "co with . I still have so questions I need to ask you. For now, try not to worry about his condition; just focus on answering my questions."
Outside the patient's room, his girlfriend was extrely worried. Liu Banxia had been very clear: multiple organ failure might occur, which sounded like a life-threatening situation.
"You saw his reaction just now," Liu Banxia began. "He was very 'calm' when he heard my description. During our earlier consultation, we speculated that his current condition might be affecting his emotions."
"I'm now certain that all the symptoms he's exhibiting are interconnected and caused by the sa pathogen."
"Doctor, what exactly is the illness?" the patient's girlfriend asked.
"We're still leaning towards a parasite. Try to recall carefully: did you eat any unusual foods? For example, seafood that you thought was cooked, but perhaps wasn't cooked thoroughly?" Liu Banxia asked.
"Or, when he eats out for work, could he have eaten any particularly unusual foods? Don't be quick to dismiss the idea; take a mont and think carefully."
After pondering for a bit, the patient's girlfriend shook her head. "I do the cooking at ho, and his workplace has a cafeteria."
"Alright, we'll focus on cooling him down first and then continue to observe him," Liu Banxia said.
The diagnostic process had once again hit an impasse. For now, there wasn't much more they could do except continue to observe.
It wasn't that if the current tests yielded no diagnosis, they would imdiately subject the patient to new ones. If that were the standard procedure, they would essentially just be inviting conflict. Otherwise, for illnesses that require two to three days or even longer to diagnose, the cost of testing alone would be enormous. Besides, many diagnostic procedures can affect the patient's body, and these factors also had to be considered.
Using an alcohol sponge bath to reduce fever doesn't an dousing the patient with alcohol from head to toe as if giving a regular bath. The aim is to reduce the fever, so focusing on areas where sweat glands are concentrated is sufficient. For instance, the palms, soles, chest, back, armpits, and groin. Wiping these areas several tis is far more effective than wiping the arms, thighs, or abdon. The cooling effect cos from the evaporation of alcohol, which draws away heat, and this is most efficient in areas with a high concentration of sweat glands.
Furthermore, high-concentration alcohol shouldn't be used directly; it should be diluted with warm water. The purpose of using warm water is to make the procedure more tolerable for the patient and to reduce discomfort.
Also, it's best to avoid this thod for children. When children have a fever, their capillaries tend to dilate. Given their thin and delicate skin, this thod can often lead to other complications.
"Teacher Liu, there are so acne marks on the patient's back, and so active acne. Could these be related to his illness?" Su Wenhao asked while sponging the patient.
Liu Banxia went around to take a look. "Probably not. These marks look old. They're likely from him scratching his acne in the past."
"The main thing is to look for any macules or papules. If there's an external manifestation, it's usually like that. SIGH... Actually, I was hoping to find so rashes, but I just checked his chest and thighs, and there weren't any."
The sponging continued, with Su Wenhao and Miao Rui working diligently. After wiping his chest, back, and the backs of his knees, they moved on to his palms, soles, and armpits.
"Teacher Liu, can you take a look at this? Acne doesn't usually develop here, does it?" Miao Rui called out while cleaning the patient's right armpit.
Liu Banxia went over to take a look.
At first glance, it did resemble the remnant of a scratched-open acne lesion. There was a small ulceration, but it had already ford a scab. However, acne rarely appears in the armpit; it usually occurs on the face and back.
To be cautious, Liu Banxia took out a flashlight and examined the lesion carefully with it.
"Sothing seems off here," Liu Banxia said after a close look. "This definitely wasn't caused by acne. Let think... I feel like I've seen sothing like this before."
"A normal scab from a picked acne lesion wouldn't look like this. Argh, my brain... It's on the tip of my tongue, why can't I recall it?" Liu Banxia muttered to himself and gently tapped his head.
Xu Yino and the others also tried to recall, but they were completely clueless.
"Right, the scab's color is a bit dark. Miao Rui, use your finger to feel the edge of it. Is it sowhat depressed?" Liu Banxia suddenly said.
Miao Rui touched the edge of the scab with his gloved finger and nodded.
"PHEW... My goodness, I've finally figured out what's going on!" Liu Banxia sighed in relief, then turned to the patient's girlfriend. "His ho is also in the north, not far from here, but did he happen to visit the south recently? Perhaps about ten days or so before his symptoms started?"
The patient's girlfriend nodded. "Yes, he did. He went to Quanzhou to handle his resignation."
"Now I can confirm the diagnosis," Liu Banxia said. "His current condition is the result of a bite from a specific type of mite."
"This mite is called a chigger. They are more common in the south and rarely seen here in the north. Moreover, the chiggers found in the north aren't as potent as those in the south; they typically don't cause such severe consequences."
DING! Consultation task completed.
Experience points earned: 300.
"Dr. Liu, does that an his body is infested with mites?" the patient's girlfriend asked anxiously.
"It's not that horrifying. You're making ** scared with that description," Liu Banxia said with a smile.
"Oral chloramphenicol. It works wonders for this illness, and it's not expensive either. It'll only take a few days. Once the chloramphenicol eradicates the pathogen in his body, he'll return to normal."
"Just dication? Chloramphenicol? You an the sa chloramphenicol that's in eye drops?" the patient's girlfriend asked incredulously.
Liu Banxia nodded with a smile. "Yes, that's the one. It's remarkably effective. However, that doesn't an taking this dication alone will resolve everything. A blood clot has already ford, so he still needs anticoagulant and thrombolytic therapy."
"Additionally, his kidneys have already experienced so degree of failure, so that also needs to be addressed. But chloramphenicol can eliminate the underlying cause, which is treating the root of the problem. So, we're now treating both the symptoms and the root cause."
"Doctor, so... is this chigger the sa as the mites you find on bedsheets?"
The patient's girlfriend had cald down considerably and now seed curious. She had heard of mites before; apparently, there are many in people's noses and even more on bedsheets. But she'd never heard of such a tiny mite causing such a severe illness in a person.
"Strictly speaking, this is a chigger. It's different from the common mites you're thinking of," Liu Banxia said after a mont's thought.
"People who frequently engage in outdoor activities are more susceptible to bites from chigger larvae. Initially, there are no symptoms. However, once the bite site ulcerates and forms a scab, the illness begins to manifest."
"But there's no major issue now. Since we've identified the cause, the subsequent treatnt will be much more straightforward. The dication will be brought over shortly, and he just needs to take it orally."
"Alright, for now, just keep an eye on his intravenous drip bag. If any issues arise, press the call bell for the nurse. We'll step out now, but we'll have the dicine sent over soon."
After saying this, Liu Banxia gave the interns a look and headed for the exit.
He'd noticed the patient's girlfriend's expression seed a bit off. Had he said too much?
The interns were sowhat perplexed, but since Liu Banxia, their leader, had spoken and was already leaving, they followed him out.
They were quite curious, though, and ntally noted to look up information about these chiggers when they got back. They seed surprisingly potent!
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