The Enhanced Doctor

Chapter 1162: Chapter 1162: Pitfalls Everywhere

"Teacher Liu, the patient’s CT results are out. There is a cyst on the pancreas, and the rest of the images are consistent with pancreatitis."

Liu Banxia was waiting for the news when Xu Yino ran over.

"Li Tianyang, explain what the patient’s CT indicates." Liu Banxia said.

"The primary consideration is the pancreatic cyst." Li Tianyang said.

"However, the current cyst is relatively small, and the patient’s pancreatic edema makes it impossible to determine if it is a true cyst or a pseudocyst. We can provide symptomatic treatment for the pancreatitis and take a biopsy of the cyst."

"Not bad, concise and to the point, right on target." Liu Banxia nodded.

"As per our usual routine, does anyone have a supplementary explanation or completely deny his answer? I look forward to it. I love watching debates, the kind where people argue until they’re red in the face."

Hearing his words, several interns nearby remained silent. Even though they knew Liu Banxia was teaching, his teachings often led into pits.

"Hey? Caught one. I see Zhang Xiaoman is hesitant to speak but eager to try, can’t hold back and wants to speak up, huh? Go ahead." Liu Banxia said after looking around.

Zhang Xiaoman from the internal medicine department looked slightly helpless, "Based on the patient’s symptoms after admission, I’m more inclined towards the likelihood of a pseudocyst."

"Pancreatic pseudocysts are often post-inflammatory pseudocysts, tumor-induced pseudocysts, or parasite-induced pseudocysts. Given the small size of the patient’s cyst, I think performing a tumor marker screening and stool test would be appropriate."

"Of course, biopsy results are more direct. However, since the patient’s pancreatic edema is quite severe, doing the biopsy after conservative treatment might be more prudent."

"OK, two people have spoken. Is there anyone more eager? This is a rare opportunity." Liu Banxia continued.

Xu Yino looked at these people with a deep sigh.

Wasn’t I just as naive when I first came here? Now they’re happily jumping into the pit. Can’t you think things through more comprehensively? How could you forget the allergic symptoms?

"I think we should first try conservative treatment and monitor the cyst condition after controlling the pancreatic edema. If there are no changes, direct surgical treatment would also be appropriate." Zhang Hongfei said.

"My reasoning is that pancreatic sampling carries some risk, and considering the current state of the patient’s pancreas, a more cautious approach is advisable."

"Comrade Zhang performed well, anyone else want to add?" Liu Banxia continued to ask.

The individuals exchanged glances, but no one spoke up. The tests that could be given were limited to those related to the pancreatic cyst. What else could be offered?

"Hey? Something’s off. Why has Xu Yino been pouting all this time? Looks like there’s something to say." Liu Banxia suddenly quipped.

Their eyes instantly shifted to Xu Yino.

"Teacher Liu, don’t sow discord. When did I pout? But I do have something to add." Xu Yino said.

"The patient currently exhibits symptoms of pancreatitis with a pancreatic cyst. However, before admission, there was a severe allergic reaction. While considering pancreatitis and the pancreatic cyst, we also need to consider the allergic reaction."

Upon hearing this, many people had a sudden realization, and looked at Liu Banxia with a troubled gaze.

This time, it wasn’t about reading the CT scan and determining what diagnoses and tests were necessary, but about having a comprehensive grasp of the patient’s symptoms.

The scan is simple, the diagnostic methods are straightforward, yet the allergic reaction was entirely overlooked.

The severe allergic reaction warranted attention. It’s not like urticaria where just resting and boosting resistance would suffice.

"Teacher Xu is quite impressive, but the rest of you weren’t too shabby either. Overall, your statements were good, but there’s still a slight gap in fully grasping the patient’s condition." Liu Banxia said with a smile.

"We’ve treated patients with severe allergic reactions before, so we’re always quite attentive to these cases. Firstly, our principle is to preemptively protect the airway under suitable conditions."

"Even though the patient’s condition is currently stable and the blood oxygen levels are fine, we can’t guarantee that an upcoming allergic reaction won’t result in acute laryngeal edema."

"At that point, invasive intubation would be necessary, increasing the risk of infection and allergic reactions for the patient, consequently placing them at higher risk."

"Some might say, intubating while the patient’s condition is still fine is excessive treatment. Analyze the specific situation, right?"

"So someone needs to stay by the patient’s side, monitoring the airway while conservatively treating the pancreatitis. If something goes wrong, intubate immediately."

"Another condition for intubation is if a second allergic reaction occurs. Does anyone have objections? Don’t just listen to me. If not, I won’t say more, let’s go eat directly."

"Teacher Liu, why?" Cui Jia asked.

"Good job, you now know how to cooperate. In situations like this, it’s like performing a comedy skit; you need someone to set the jokes and someone to complement them," Liu Banxia said with a smile.

"Because it proves that there might be some substance in the hospital causing the patient’s allergy. Since it happened a second time, there will be a third and fourth time. Why wait to intubate?"

"But I’m still very pleased that you all considered the high risks involved in a pancreatic biopsy. You didn’t just rush in with a biopsy needle out of urgence."

"When it comes to examinations, especially invasive ones, we must be extremely cautious. Our invasive examinations could very likely exacerbate the patient’s symptoms."

"Considering this patient’s situation—pancreatitis, pancreatic cyst, allergen—let’s follow Teacher Xu’s treatment plan, leave an intubation expert on standby, and let’s go eat. I’m adding dishes."

"I’ll stay, I want a chicken leg," Cui Jia hurriedly said.

"Yes, that’s the spirit. Be confident. So, Comrade Cui Jia is this month’s intubation expert; responsible for supervising and guiding the intubation work."

After Liu Banxia finished speaking, he left the office with his hands behind his back and went straight to eat.

Cui Jia was a bit stunned. What intubation expert? I just wanted a chicken leg. It’s a fine tradition at the emergency center, a chicken leg with mysterious power.

"Did the big boss trick you? Come with me, the blood test results should be out soon," Xu Yino said.

"What we need to prepare now is the anti-allergy medication. If the patient has another allergic reaction, we’ll need to perform emergency allergy treatment."

"The big boss won’t directly tell you this; he’s setting a trap for you. Don’t think that just because he’s gone, there are no spies around; traps are everywhere."

"Senior sister, I noticed Teacher Liu seemed very relaxed. Does he already have a handle on this patient’s situation?" Xu Zhenkai asked.

Xu Yino shook her head with a wry smile, "That’s another special attribute of the big boss. He’s encountered a tough problem. When have you ever seen him leave a patient alone without worrying and go eat by himself?"

"Basically, he can be described as capricious. The more relaxed his expression, the more playful his words, it indicates he’s digging a pit or very anxious."

"But he won’t show this kind of anxiety to avoid affecting everyone’s mood, so he adjusts himself, relaxes, and switches perspectives to think."

"This experience comes from being trapped so many times. Anyway, just keep it in mind. Regarding patient examinations, let me just mention it."

"Currently, the situation with the pancreatic cyst is still uncertain. We can do some screening examinations with small projects. If nothing comes out or the indications are clear, then we can perform invasive and high-cost examinations."

"These are also my insights after following the diagnosis today. We must reasonably utilize the hospital’s medical resources and consider the patient’s actual situation."

"This actual situation not only includes the patient’s symptoms, but also considers the family’s overall situation and so on. Simply put, think from the patient’s perspective."

Everyone nodded together, what Xu Yino said was pure experience, very practical insights.

To learn from the big boss in the long term, you have to get used to his consultation style, only then can you cooperate well.

And for these interns and resident trainees, the teacher they most want to follow and learn from now is Liu Banxia.

This is also a relatively relaxed area in the emergency center; anyone with time can know the subjects that interest them.

As Xu Yino just mentioned, though it seems playful, it’s also Liu Banxia’s style, which counts as his charisma.

Even if he sets a trap for you, you still jump in without hesitation; he’ll always pull you out and explain the related issues clearly.

As for this patient, conservative treatment is the main approach for now.

The pancreatitis is in its initial phase, with symptoms not yet very apparent. After making appropriate arrangements, Xu Yino sat by the examination bed for a while longer with the patient.

In fact, the patient’s situation has reached the standard for ICU transfer, but since the symptoms are not clear and can be managed on-site, there’s no need to burden the ICU.

Liu Banxia once said that the ICU is the last line of defense, and it’s up to people like them to guard it. You can’t just throw problems at the ICU at the first sign of difficulty, nor can you recklessly refuse to send patients to the ICU.

This also applies to seeking consultations; when indications are unclear, make your own judgment first.

There are so many patients now, everyone has many to attend to, and receiving your consultation request can disrupt their plans.

So you need to assess when to handle it yourself and when to seek consultation; this process is actually quite challenging.

Even though his choices may seem unclear, everyone enjoys it.

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