(Thank you to English Jay, Silent Guardian, Be Gentle With , Savage Shaomai, and Peaceful Moon for the ticket encouragent.)
"Actually, bone-setting isn't all that complex, and its difficulty also depends on your specific injury," said Liu Banxia in response to their curious gazes.
"Your injury isn't too complex in the first place. It's likely that your arm was impacted during the car accident, a sort of jolt of force. The fracture itself is quite clean, with no bone fragnts."
"Even the most skilled bone-setting techniques would be ineffective against complex fractures because you can't feel or realign tiny bone fragnts to the exact fracture site."
"We should take an X-ray, which might be a bit uncomfortable. As the saying goes, 'An injury to muscle or bone takes a hundred days to heal,' so there's so truth to that."
"Thank you, Doctor. I'll get ready for the X-ray." The patient sohow looked a bit happier.
When he first arrived, the whole situation was bewildering. He was still in shock from the accident. After waiting a while here, he realized that although his injuries weren't light, they weren't as severe as those of patients heading for surgery. This realization brought him a asure of comfort. It's not that he was heartless, hoping others were worse off. In such situations, one tends to rationalize things this way to find solace. This is just human nature. After all, after such an incident, what else could he expect?
"Dr. Liu, you're truly amazing. No wonder Wang Chao keeps singing your praises," Ma Limin exclaid.
"Wang Chao praised ? I'd say it's good enough that he didn't belittle ," Liu Banxia casually replied.
"Not just once or twice. He said your dical skills are incredible and that you learn very quickly. He ntioned that you can perform many surgeries independently after participating just once," Ma Limin said.
"He can't do that. In terms of performing surgeries and diagnosing conditions, he's far behind you. But he's content now; at least he's improved much more than he expected."
"If that kid is giving such high praise, I should reward him with an extra chicken leg tonight," Liu Banxia joked.
"You carry on with your work; I still have a few things to hand over." Realizing she might have said a bit too much, Ma Limin hastily excused herself and disappeared.
Shaking his head, Liu Banxia realized that Wang Chao had been subtly working in the background.
The matter between Wang Chao and Ma Limin could be considered later during his break. For now, there were still patients to attend to. He glanced around and saw that Wei Yuan and the interns had nearly finished with most of the cases.
"Brother Wei, co over here a minute; there's a case we need to discuss," Liu Banxia called out.
"Finally wrapping up. Is the fracture set?" Wei Yuan asked as he approached.
"Just finished treating it and sent him for an X-ray. The patient with the vascular rupture has elevated lactate levels, up to 6, and her pH value is stuck at the lower limit," Liu Banxia reported.
"Right now, I'm having trouble determining if it's a physiological increase or if there's so other underlying condition. Help think this through. Is it possible that it's due to physical activity yesterday, compounded by the car accident?"
Upon hearing this, Wei Yuan furrowed his brow and took the dical report.
Many factors can cause a rise in lactate levels, with tissue hypoxia being the most significant. Tissue hypoxia itself can stem from a wide range of pathological conditions, such as respiratory failure, circulatory failure, shock, or blood diseases. Another reason might be abnormal glucose tabolism in the body. If glycolysis rates increase, or after strenuous exercise or dehydration, these can also lead to elevated lactate.
"Banxia, it's hard to confirm without asking the patient. She's in the operating room for suturing right now, isn't she?" Wei Yuan asked.
Liu Banxia nodded. "My personal inclination is that a specific tissue or organ might have a problem, with ischemia in that area leading to the elevated lactate."
"From triage, the patient doesn't seem like soone who regularly exercises. She also doesn't appear to be dehydrated from diarrhea; otherwise, she likely wouldn't have been able to drive."
"However, I'm still unable to determine whether the high lactate is due to significant blood loss from this accident, especially since her blood pH remains at the lower limit."
"But if there really is an issue with an organ inside her body, I worry that it will affect the treatnt. What if it's an acute disease onset? We might have repaired the blood vessels but overlooked another underlying condition."
"Even if it's not life-threatening, she might have to return to the operating table. Do you think we should ask Dr. Shi to perform a comprehensive ultrasound during the surgery to look for any abnormalities in the chest and abdon?"
"Chen Xuehai handled the initial admission, so he definitely did so related checks. But at that ti, the focus was mainly on whether there was any fluid accumulation in the chest and abdon, and particularly on the bleeding blood vessel."
"The main issue right now is that the indications aren't clear enough. If only the pH value would drop a little more, we'd have a specific target," Wei Yuan said with a wry smile.
"The car accident today was severe. If we don't adhere to procedure during the dical process, it might lead to complications."
"Isn't the decision made by the two of you doctors sufficient?" Director Fang, who had approached at so point, asked.
Liu Banxia shook his head. "Our intention is for the patient's best interest. Currently, there's an abnormal result in the blood test, which has drawn our attention."
"But this abnormality could be pathological or physiological. If it's physiological and we perform related tests, it might be considered overdoing it."
"Actually, we could also wait until after the surgery, then consult with the patient and see if her account indicates a need for further tests."
"Such a delay might result in the patient having to undergo a second surgery. It's not about the extra cost, but the significant harm caused by two operations in quick succession."
"Another reason is that we only have a guess right now. Therefore, we would be sowhat unfocused in ordering examinations, and there might be more than one necessary test," Wei Yuan added.
The final decision had to be made by Liu Banxia since he was the chief resident and the one who triaged the patient. However, Wei Yuan didn't want Liu Banxia to be impulsive. This wasn't a money issue; the impact would be significant. If the patient truly had no other problems, and Liu Banxia still advocated for the examination, so people might say he insisted on it to make a show, leading to such an arrangent. Not finding anything in the examination would be fine, but if sothing was detected, it would be a mont for him to shine. But Wei Yuan knew Liu Banxia's personality; he wasn't soone who liked to show off. Otherwise, he would have been in the operating room today, not doing triage and assigning the surgeries to others.
"I should give Shi Lei a call. He should have repaired the blood vessel by now," Liu Banxia said after so thought.
After a short wait, the call connected. Liu Banxia put it on speakerphone. "Can you find Dr. Shi? Did he notice the elevated lactate?"
"Dr. Liu, Dr. Shi noticed too. But he's suturing now. He asked for your opinion," the circulating nurse said.
"Dr. Wei and I are discussing it now. The indications aren't clear, so we want to ask for Shi Lei's opinion. I'll wait for his call after he finishes suturing," Liu Banxia said.
"Dr. Liu, please wait a mont; Dr. Shi has just finished suturing," the nurse said.
"Banxia, you noticed it too? Puzzling, isn't it?" Shi Lei's voice ca through.
"Yeah, I've been discussing it with Brother Wei for a while but still can't decide," Liu Banxia said.
"There's another situation here. The number of surgeries suddenly increased this afternoon. Wang Lei and the others are rushing between operating rooms. We need to make a decision quickly," Shi Lei said.
"I still lean towards doing the examination. Otherwise, her car wouldn't have taken such a trajectory, right? This isn't a highway exit, just an expressway entrance," Liu Banxia said.
"Alright, has her family arrived yet?" Shi Lei asked.
"Not yet. She's not from Binhai City, and her phone is broken. Otherwise, I would have consulted her relatives directly. What do you think?" Liu Banxia asked.
"I'm also inclined to do the ultrasound first. It's possible the fluid resuscitation is why her blood pH hasn't dropped further. If an organ is malfunctioning, considering she was driving, it might be an acute condition," Shi Lei said.
"OK, let's settle on that. But for now, all we can really do is an ultrasound, right?" Liu Banxia said.
"We can only do our best. I'll go perform the examination now." Shi Lei hung up.
"Dr. Liu, aren't you afraid of taking responsibility?" Director Fang asked.
"Actually, situations like this happen quite often," Liu Banxia said, shaking his head.
"We have ergency services, and many patients are brought in by ambulance. When we can't contact their families, we have to make decisions for the patients."
"Our ergency departnt is required to prioritize patients' lives. However, our rescue attempts might not always be successful, which can lead to conflicts over dical expenses."
"And then there are situations like today. Our intention is for the patient's benefit, to aid in their recovery. If there's indeed an acute organic lesion, like appendicitis, by the ti the patient recovers from general anesthesia, the appendix might have already perforated."
"As you just heard from our discussion, many situations are complicated and can lead to nurous outcos. Yet, we need to make decisions in a short amount of ti, which indeed carries risks."
Director Fang nodded in understanding. This was his first ti truly experiencing such a situation.
Many tis, many things are ultimately judged by their outco. If sothing truly went wrong, Liu Banxia and the others wouldn't face disciplinary action, but it would sowhat affect their reputations.
And for a doctor, reputation is crucial because it can directly influence a patient's choice of physician when seeking dical treatnt.
User Comments
0 comments from readers