The Enhanced Doctor

Chapter 1209: Chapter 1209: Stalemate

"How are the enhanced CT results?"

Seeing them return with the patient, Liu Banxia quickly asked.

"Negative, the cardiovascular and lung vessels have no issues, completely clean," Chen Xuehai said, frowning.

"Geez, this is really troublesome," Liu Banxia’s brow furrowed as well.

Now it’s quite troublesome; there’s no direction for the next examination.

The patient’s current data shows two problematic indicators: one is the platelet count, and the other is brain natriuretic peptide. The other blood test results and electrolyte levels are all up to standard.

Normally, such high levels of brain natriuretic peptide should manifest as symptoms of heart failure.

Echocardiogram negative, ECG negative, enhanced CT negative, ruling out myocardial infarction and pulmonary embolism. How to proceed with the examination?

"Old Chen, do you have any direction?" Liu Banxia asked quietly.

The patient shouldn’t overhear this, as it can cause concern. The patient’s condition hasn’t been clarified yet; if a sudden shock exacerbates the patient’s symptoms, it will be difficult to handle.

"Currently, I don’t have a good idea; we can only treat the symptoms. First, administer some drugs to increase platelet count, then reduce the brain natriuretic peptide levels," Chen Xuehai said.

"But we also need to consult internal medicine; this seems no longer our issue in cardiac surgery, as both the lungs and heart appear fine."

He wasn’t shirking responsibility but intended to offer the best diagnostic service for the patient.

Diagnosis is a serious academic pursuit. Initially, whether the problem was pulmonary or cardiac, as a cardiac surgeon, he had the expertise to weigh in.

However, this series of tests has ruled out the most likely pulmonary and cardiac issues. If there are other symptoms, it’s not his area of expertise.

Moreover, the patient has already undergone multiple tests, including enhanced CT, so the next steps need to be cautious.

Therefore, we need to find a specialist to at least quickly identify the general direction of the patient’s symptoms.

"Is there a possibility of myocarditis? What if the symptoms are in the early stages?" Liu Banxia asked.

Chen Xuehai thought for a moment and shook his head, "Very unlikely; his blood pressure is still acceptable, and his body temperature isn’t that high. Coupled with his ECG; if it were myocarditis, it would certainly be reflected in the ECG and troponin levels."

"The gold standard for testing myocarditis is a biopsy, but considering the patient’s condition, even if the patient agrees, we need to be cautious."

Liu Banxia nodded; this consideration is quite reasonable.

An invasive test is equivalent to surgery; it’s best to avoid it if possible.

The enhanced CT was unavoidable, a must-do.

"Li Hao, see who’s in internal medicine, call them over to discuss together," Liu Banxia said.

Li Hao hurriedly ran to the internal medicine consultation room. He also knew that the patient he admitted seemed to have a peculiar condition.

"We also need to contact his family. The current oxygen levels, although stable, are under our high-flow oxygen supply. We can’t predict when they might drop, and then a ventilator would be necessary," Chen Xuehai said.

"Okay, let Li Hao inform the patient when he returns." Liu Banxia nodded.

"You all should go eat; we’ll keep an eye on things."

At this time, Qi Wentai and the first batch of people who had gone to eat returned.

"We still need to wait a bit; the patient’s condition is quite complicated. Brother Xu, Brother Wang, you both help to provide some input. Li Hao will describe the patient’s condition, then notify the patient to contact their family," Liu Banxia said.

Li Hao quickly presented the patient’s condition in detail once again.

"If an internal medicine condition triggered this, then is it an endocrine issue? Yet it’s only the brain natriuretic peptide levels that are abnormal," Wang Huan said.

"Old Peng, you’re just in time, please have a look too," seeing Peng Bo, Liu Banxia quickly called out.

"Let’s go to the office; it’s too chaotic here. Liu Yiqing, make another run and bring us some meals back; we don’t have the mindset to go to the cafeteria to eat."

Everyone followed him to the large office on the first floor, coincidentally seen by Zhou Shuwen returning from lunch.

It’s quite reassuring; encountering challenging cases and discussing them together is serious business.

Doctors shouldn’t have an oversized ego, always thinking of solving every case alone. The consultation frequency at the emergency center is the highest, and for this reason, many conditions have a high diagnosis rate, and the diagnostic process is quick.

He had no intention of participating; if this group couldn’t sort it out, his involvement wouldn’t help much. They hadn’t invited him, which means they’re still deliberating.

This is one of Liu Banxia’s contributions. He enjoys consultations the most in the emergency center. Naturally, this motivates others and strengthens inter-department collaboration.

Liu Banxia didn’t know that Zhou Shuwen was praising him inside, now the room full of doctors felt a bit overwhelmed.

"If it doesn’t work, let’s use a big move and check rheumatism immunity?" Xu Hui asked.

"There are currently few symptoms, and the patient doesn’t have rashes or other disease manifestations. It always feels like a shot in the dark." Liu Banxia said.

"Unlike our last patient, whose interrelated symptoms were many. This patient just has cold symptoms, mild pneumonia, difficulty breathing, and positive platelet and brain natriuretic peptide indicators."

"Old Peng, could it be a brain issue?" Chen Xuehai asked Peng Bo.

"We can check to see if there are any organic lesions. However, if there are organic lesions, his symptoms should be more varied now." Peng Bo said.

"I can recommend two checks: a head MRI and a spinal tap, which can help rule out more issues."

"But the patient already underwent an enhanced CT today, it’s best to do the spinal tap tomorrow. We can also use this time to observe if the patient’s symptoms develop further, or if other new symptoms appear."

"That’s basically the situation. Although the patient has a history of diarrhea, it’s already improved. And from the examination results, the body’s electrolytes aren’t imbalanced." Wang Huan said.

"Does anyone have other ideas?" Liu Banxia asked.

"That’s about it? It doesn’t look like an abdominal organ issue, right? How were the conditions of the spleen during Li Hao’s hand diagnosis?" Chen Xuehai asked.

"During the hand diagnosis, the spleen showed no abnormalities." Li Hao quickly said.

"Has the patient’s family been contacted?" Liu Banxia asked.

"Contacted, both parents have been informed." Li Hao said.

At this time, Liu Yiqing also came in with food, and those like Liu Banxia who hadn’t eaten hurriedly started to eat.

"Li Hao, does the patient have any spontaneous bleeding points?" Xu Hui asked.

"I’ve checked the patient’s arms, legs, abdomen, and chest, and found no bleeding points, nor any symptoms of nosebleeds." Li Hao said.

"The examination is very thorough, from this perspective, the patient indeed fits the condition of reduced platelets caused by respiratory distress." Xu Hui nodded.

"If that’s the case, personally I also lean towards a brain-related issue. Heart and lungs, our current examinations can rule them out."

"Li Hao, pay close attention to the patient’s condition. The patient’s respiratory distress symptoms are showing signs of worsening, so check the platelet count again in two hours."

"It could also be due to medication, hasn’t he taken quite a lot of cold medicine, which all can have effects. As for his lung condition, I personally think there’s nothing wrong."

"Inflammation manifestations are too mild, and no signs of atelectasis or bronchial disease were seen during the examination. What do you all think?"

"I quite agree with Doctor Xu’s view, judging from the current symptom manifestations, it does appear to be the case." Chen Xuehai nodded.

"Then we’ll make a preliminary judgment." Liu Banxia said after swallowing the food in his mouth.

"Let’s observe first. Once the patient’s family arrives, we’ll consider performing a head MRI. Also inform them of the potential acute respiratory distress syndrome and prepare for the possibility of using a ventilator."

"As the symptoms progress, we’ll also see if a spinal tap should be done. First, put the patient on the diagnosis bed, and then see if they need to be sent to neurology, how about it?"

"Okay, this sounds good." Chen Xuehai said.

"Yeah, the symptom manifestations still feel a bit odd. But if acute respiratory distress does occur and a ventilator is required, I suggest still doing a spinal tap, which might be more secure." Peng Bo said.

"Although the spinal tap is relatively more invasive to the patient, if it really is a neurological disease, the spinal tap examination is still necessary."

"OK, let’s settle on this first." Liu Banxia decided.

He organized the group consultation, and now everyone’s discussion opinions were unified.

The next step is to observe and see how the patient’s blood oxygen levels are, and whether the symptoms of respiratory distress will worsen.

If it worsens, a critical illness notice needs to be issued, and at the same time, it’s essential to try to gain the agreement of the patient’s family for the spinal tap.

Although the relevant examinations only require the patient’s own consent, given the patient’s current state, it’s challenging to make an objective and fair judgment, so their family’s opinion is needed.

Everyone went off to do their respective tasks, Li Hao’s afternoon duty was also to monitor this patient.

Feeling somewhat overwhelmed, the symptom manifestations are few, and without clear indications, the condition is really hard to diagnose.

Diagnosing a disease is like solving a problem, the fewer known conditions given, the harder it can sometimes be to solve. Too many known conditions aren’t good either, as it might lead to a feeling of being dazzled.

We need to judge which conditions need not be considered, and which known conditions are necessary for solving the problem at hand.

Currently, it’s stuck in a stalemate; to put it nicely, it’s just observing for now.

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