The Enhanced Doctor

Chapter 1210: Chapter 1210: What If It Wasn’t Just Fatigue?

"Teacher Liu, do you think the patient has a neurological disease?"

Li Hao asked.

"It’s hard to say for sure at the moment, but with the heart and lungs ruled out and so few symptoms present, we can only lean towards a neurological judgment," Liu Banxia said.

"The patient is in decent shape and hasn’t experienced rapid weight loss; otherwise, we might consider an HIV screening. The current situation is really challenging to assess."

"Director Liu, Doctor Li, the patient’s parents have arrived," the nurse approached at this moment.

Liu Banxia nodded, "You should go and provide an introduction. You’ll need to adapt to these tasks soon; your time to handle admissions independently is running out."

Li Hao nodded in acknowledgment.

This is also a tricky situation; if the patient’s condition were clearer, it would be much easier. With so many tests done and the situation still unresolved, dealing with difficult relatives can lead to complaints.

Liu Banxia temporarily left Li Hao’s situation alone, still recalling the patient’s conditions.

The symptoms displayed by the patient aren’t actually few; when you think about it, headaches, nausea, and fatigue do align with some neurological disorder manifestations.

As he was pondering this, the patient’s monitor started beeping urgently.

"Teacher Liu, the blood oxygen level is dropping rapidly, and the heart rate is increasing. We need to put the patient on a ventilator," Li Hao said.

"Have you informed the family?" Liu Banxia asked.

"Just finished informing them."

Li Hao said as he closed the curtain to prepare the patient for intubation.

"Doctor, what exactly is wrong?" the patient’s mother asked anxiously.

"We are still investigating; we’ve eliminated heart and lung issues, but we now suspect some kind of cerebral condition," Liu Banxia said.

"After intubation, we’ll first check the blood oxygen levels. Then we’ll do an MRI of the brain and decide if a lumbar puncture is needed to test the cerebrospinal fluid."

"Doctor, will that be able to diagnose it?" the patient’s mother asked.

Liu Banxia paused; he wanted to give a reassuring answer but hesitated to promise too much.

"Did you notice any abnormal behavior at home recently?" Liu Banxia asked.

"At home? He had diarrhea recently, then caught a cold. Medication didn’t help much, so we decided to come to the hospital for a check-up today," the patient’s mother said.

"He’s been feeling weak and lacks an appetite. He’s taken a lot of medicine, but the cold isn’t improving. Normally, colds last about a week, but he’s been like this for half a month."

Liu Banxia nodded.

The platelet situation is leaning towards a drug reaction, which isn’t too concerning. But the immediate issue is the patient’s respiratory distress.

At this time, Li Hao also emerged, "Teacher Liu, intubation is complete; we’ve started with 100% oxygen, and will adjust down once the oxygen levels improve. The heart rate has also dropped to 100."

"Once the oxygen levels stabilize, we can consider giving a dose of adrenaline to boost the blood pressure," Liu Banxia said.

Li Hao nodded, "Teacher Liu, the patient’s current symptoms resemble hypokalemia, yet both blood potassium and the ECG look normal."

"Many conditions have similar symptoms, but we need to identify the cause of the respiratory failure. In this situation... hmm... call Doctor Peng over," Liu Banxia paused while speaking.

Li Hao didn’t hesitate, quickly running over.

"Don’t worry, we’ll consult with a neurologist again. Our previous consultation suggests the symptoms are neurologically-based," Liu Banxia reassured the patient’s parents.

"Director Liu, are we going to do a lumbar puncture?" Peng Bo asked as he arrived.

"Doctor Peng, what if the patient’s fatigue symptoms are changed to muscle weakness or reduced muscle strength?" Liu Banxia asked.

"Muscle weakness or reduced muscle strength?" Peng Bo repeated.

If that’s the case, then the patient’s respiratory issues might be due to respiratory muscle paralysis. If so, with the patient’s other electrolyte indices fitting, it could potentially be AIDP?"

"Indeed, it aligns; he had diarrhea, which often precedes GBS. We’ll do an electromyography, then a lumbar puncture to check for protein-cell separation in the cerebrospinal fluid."

"If both are positive, we can almost confirm the diagnosis. However, a blood test for antibodies is needed, but we can begin treatment immediately."

"Thinking back, it makes sense, but didn’t you observe the patient’s gait? Muscle weakness and fatigue exhibit different gait patterns."

Peng Bo was surprised by this, and he used fatigue as a diagnostic criterion.

Given Liu Banxia’s expertise, he shouldn’t have mixed up these two conditions.

"At that time, the patient’s condition was merely a display of fatigue, walking was not really a problem, just appeared a bit haggard," Liu Banxia said with a bitter smile.

"Later, due to the patient’s difficulty in breathing, we didn’t give it much thought. After all, breathing was already challenging, so rushing anywhere would certainly be exhausting."

"Just now Li Hao mentioned that the patient’s symptoms resemble hypokalemia somewhat, and hypokalemia is just respiratory muscle paralysis. Yet, the patient’s blood potassium level is normal, which is one cause, we seldom considered during our discussion."

"Apart from the heart and lungs, there’s also the respiratory muscle affecting the patient’s breathing. Alas... a more severe manifestation of symptoms upon the patient’s visit would have been better."

This can’t be blamed on Li Hao either, as he observed the patient’s past payment and examination gait, which wasn’t as severe as typically seen in patients with muscle weakness.

Furthermore, many patients exhibit weakness and drowsiness after taking cold medicine, which is a normal drug reaction.

"The patient’s family has arrived, right? I will talk to them, and then proceed with the corresponding examinations," Peng Bo said.

"Actually, judging from the electromyogram response, you can pretty much see it. But we can’t blindly medicate; just respiratory muscle paralysis and electromyogram aren’t enough for medication standards."

"I remember the medication for this is either immunoglobulin or plasma exchange, right?" Liu Banxia asked.

Peng Bo nodded, "Considering it comprehensively, immunoglobulin is better. I will first talk to the family and then push for the electromyography, no need for MRI just yet."

Peng Bo, being experienced in the martial world, simply explained the current situation to the patient’s parents, who agreed with his two recommended examination options.

"Teacher Liu, do you think I misdiagnosed?"

After Peng Bo left with the patient, Li Hao carefully asked.

Liu Banxia patted his shoulder, "If counted, it’s the two of us misdiagnosing together."

"No, Teacher Liu, I’m not afraid of taking responsibility. It’s just that I should have asked him deeper about his fatigue and conducted a muscle strength test at the time," Li Hao quickly said.

"So, you’re still questioning my medical diagnostic standards," Liu Banxia said.

"Anyway, I didn’t notice any muscle weakness signs in the patient’s condition at the time; just seemed a bit listless, but when walking, he could lift his foot completely instead of dragging it along the ground."

"It’s part of the disease progression, muscle weakness also has a process. The early symptoms weren’t obvious, and as they became more pronounced, his actions were restricted by respiratory distress."

"Don’t overthink it, the occurrence of this disease isn’t very high, and the symptoms are progressive, making it not easy to grasp."

Listening to Liu Banxia’s words made Li Hao feel relieved.

In just a few hours, the patient’s symptoms changed from merely laborious breathing to respiratory distress syndrome. For this disease to be truly confirmed would require some time to recover.

Liu Banxia also felt relieved, having finally diagnosed it without any delay, within a day of admission.

However, the following examination results depend on Peng Bo, hoping there’s no further incident. This disease is indeed challenging to diagnose, especially since the patient’s symptoms showed a bit of deceptiveness.

"Director Liu, judging from the electromyographic results, it matches AIDP well. Let’s admit the patient to our neurology department, conduct cerebrospinal fluid tests, and if positive, proceed with immunoglobulin treatment."

After a while, Peng Bo returned.

"No need to push to ICU?" Liu Banxia asked.

"Currently, it’s unnecessary, as our timely discovery maintains his condition relatively mild," Peng Bo said.

"Alright, then it’s up to you now." Liu Banxia nodded with a smile.

Although not yet confirmed, it’s mostly certain.

Actually, AIDP is a manifestation of a major illness, the full name of this disease is Guillain-Barré Syndrome or Green Barrel Syndrome.

The patient’s symptoms currently belong to the classic type of this disease, known as Acute Inflammatory Demyelinating Polyneuropathy, abbreviated as AIDP.

The patient’s current display already meets the diagnostic criteria for the disease.

The patient’s diarrhea is a precursor infection history, with symptoms rapidly peaking within around two weeks. Moreover, the symptoms progressively worsen, fitting the patient.

"Pretty much can confirm now? Didn’t expect it to be neurology’s case," Chen Xuehai, upon hearing the news, also joined.

"Almost, Peng Bo has rich experience, can make an approximate judgment just by looking at the electromyogram," Liu Banxia said with a smile.

"Been round and round, how come we just focused on the heart and lungs?" Chen Xuehai sighed.

"First reason, deceived by symptoms, second reason, the content of BNP," Liu Banxia said.

"However, I don’t know much about AIDP, only seen some disease introductions. Anyway, we’ve diagnosed it, that’s a success."

Chen Xuehai was pleased as well, certainly considered successful without dragging into the next day.

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