The Enhanced Doctor

Chapter 1255: Chapter 1255: Clouded Cerebrospinal Fluid

(Thanks to Panda Monthly Ticket for encouragement)

"Teacher Liu, the blood test results are out. White blood cells 10.4, neutrophils 93%, lymphocytes 5%, platelets 93."

After the results came out, Xu Yino ran to Liu Banxia with the report.

"It seems the problem is indeed quite severe." Liu Banxia frowned and took the report.

The anomalies Xu Yino murmured about were quite obvious on the report.

For instance, the normal range for adult white blood cell count is between 4.0-10.0, and the patient’s is clearly high. Neutrophils typically occupy about 55%-70%, but the patient’s is 93%, which is significantly higher.

The normal range for lymphocytes in peripheral blood is 20%-40%, and the patient’s is not just low—it is extremely low at 5%.

The normal range for platelets is 100-350, and the patient’s count is 93, which is also somewhat low.

Elevated white blood cells indicate inflammation or infection in the patient, and such a high neutrophil count also shows they are working hard, often suggesting a suppurative infection.

Low lymphocytes, similar to the neutrophil case, also indicate an acute bacterial infection, probably suppurative.

There are many causes for reduced platelets, both physiological and pathological.

However, since the patient has also been taking medication at home, this can be set aside for now, as some medications can affect platelet count.

"I won’t say too much. What do you think should be done next?" Liu Banxia asked after placing the report aside.

"I’m considering additional urine tests and blood cultures for the patient, and... I plan to perform a lumbar puncture." Xu Yino said.

"And your reason?" Liu Banxia asked.

"Considering the patient’s high fever symptoms." Xu Yino replied.

"Judging from the current test results, the patient’s infection is very severe. Coupled with the patient’s high fever, I’m inclined to think it’s a suppurative infection."

"The patient’s platelet count is a bit low. Although we cannot rule out the possibility of it being medication-related, it seems prudent to check if there is occult blood in the urine or stool tests, right?"

"Even though the patient’s indicators aren’t very obvious now, if it really is a suppurative infection, the patient’s temperature will continue to rise."

"The patient also has a headache, so I think a cerebrospinal fluid examination is quite necessary. But, performing a lumbar puncture now, isn’t it a bit rushed?"

Liu Banxia shook his head with a smile, "Whether it’s rushed isn’t for us to decide, but since we’ve considered this possibility, we must take it seriously."

"Acute abdominal pain, chest pain, patients with high fever—they are often the ones we need to pay special attention to. The patient you diagnosed—do whatever tests you think are necessary."

Xu Yino wrinkled her nose, feeling something wasn’t right. Did the great demon king agree too quickly?

"Why aren’t you going to communicate with the patient?" Liu Banxia asked.

"Something doesn’t feel right. I need to think and see where there might be oversights." Xu Yino replied.

"Uh...I should also check the tonsils. Although the patient hasn’t specifically mentioned symptoms of throat pain, it might be a suppurative infection of the tonsils."

After saying this, Xu Yino ran towards the patient’s examination bed, realizing she had just missed a diagnosis.

Upon admitting the patient, she focused too much on the patient’s abdominal pain and diarrhea. Although she questioned the high fever internally, she only briefly considered an upper respiratory tract infection.

Her initial thought was that once the blood test results were out, she’d have a closer idea.

No wonder the great demon king seemed to have something to say back then. It’s her fault for being too hasty.

"Is it intended to let go formally after New Year?" Qi Wentai asked.

"More or less. I usually protect them too much, leading to their bad habit of coming to me every time they encounter a problem." Liu Banxia replied.

"This doesn’t help them think independently. Many issues I mention will have less impact compared to them discovering slowly on their own. It’s like the current patient. They got so happy they forgot to check for upper respiratory tract infections."

"But it’s still within an acceptable range. It’s better than those colleagues who don’t ask anything, just prescribe blood tests directly. And she remembered it afterward, which is still commendable."

"I worry that your constant criticism of her might make her lose confidence." Qi Wentai said.

"Her? Don’t be ridiculous. Liu Yiqing needs occasional encouragement to build confidence. But Xu Yino has to be kept in check at all times." Liu Banxia replied.

"Otherwise, with her personality, she’d literally climb the walls. Even renting a place, she could exhaust real estate agents. That’s a skill I don’t have."

Qi Wentai laughed, thinking of Xu Yino’s somewhat high-profile personality. It’s indeed something to be mindful of.

But he didn’t really think Liu Banxia had much advantage over Xu Yino in that aspect, as he used to be even more flamboyant than Xu Yino.

"Teacher Liu, I’ve finished examining, and the patient’s tonsils show no signs of suppuration. There’s no cough or phlegm either, so I just informed the patient about the need for a lumbar puncture." Xu Yino ran over.

"Impressive, then let’s go ahead." Liu Banxia said with a smile.

Xu Yino frowned, "Why are you flattering me? Are you mocking me?"

"No, President Qi said to encourage you more, not to suppress you constantly. It’s genuine praise." Liu Banxia replied.

Xu Yino didn’t believe it. The compliment earlier was insincere, like fooling a child.

But there’s no choice now; the patient is more important.

Perhaps because the spinal tap is quite risky, Liu Banxia didn’t continue resting. They could perform it, but if he had time, he should oversee it.

For Xu Yino, a spinal tap wasn’t that difficult. After positioning the patient correctly, she began the procedure.

But upon seeing the extracted cerebrospinal fluid, Liu Banxia’s eyebrows furrowed into a big knot.

The cerebrospinal fluid currently appeared pale yellow and somewhat cloudy.

Normal cerebrospinal fluid is colorless and clear. Pale yellow indicates high protein content, and cloudiness suggests bacterial infection.

"Teacher Liu..."

While slowly draining the cerebrospinal fluid, Xu Yino softly called out.

"Do a culture and smear, and also perform biochemical tests." Liu Banxia instructed.

"Doctor, what’s wrong with me?"

Lying on the bed, the patient became anxious upon hearing their conversation.

"Don’t panic; let me finish collecting the cerebrospinal fluid." Xu Yino quickly advised.

"You’ve had high fever symptoms, so we need to determine what’s causing it. Teacher Liu is my mentor, so his opinion is more authoritative."

"Don’t worry, don’t panic and don’t rush. Our Teacher Liu is very skilled. We’ll have to wait for the test results; just giving you medication to lower the fever isn’t enough. That’s treating the symptoms, not the cause."

She could only say some harmless little lies now. Actually, when collecting the cerebrospinal fluid, she shouldn’t have spoken.

It truly scared her because even without testing the cerebrospinal fluid, the patient’s condition could be diagnosed as bacterial meningitis.

Later tests will determine what type of bacteria it is, allowing targeted treatment to help the patient through the crisis.

The patient seems to be in the early stages of onset; otherwise, as the symptoms develop, there could be projectile vomiting and elevated intracranial pressure, among other symptoms.

Thinking about this possibility made her worried; this disease can be fatal if not treated promptly.

But now, the patient is undergoing a spinal tap, and if his body reacts out of agitation, it would be extremely dangerous.

Finally, the cerebrospinal fluid collection was completed, and Liu Yiqing quickly had the nurse rush it to the lab for expedited processing.

"Teacher Liu, how should we administer the medication?" Xu Yino pulled Liu Banxia aside.

"What are your plans for this patient next? Let me hear." Liu Banxia asked.

"The symptoms are still mild, so I plan to try medication first. If we directly move him to the ICU, it will add to his burden, and we should wait for the cerebrospinal fluid test results for treatment direction." Xu Yino replied.

"If... if it truly becomes severe, with other symptoms appearing, then we’ll issue a critical condition notice and transfer him to the ICU. However, I’m not very confident about the medication aspect."

Liu Banxia nodded, "Your consideration here is genuinely praiseworthy. Use penicillin and meropenem, and also pay attention to the patient’s intracranial pressure."

"Our cerebrospinal fluid extraction helped alleviate it to some extent ahead of time. But bacterial meningitis, especially suppurative meningitis in this patient, progresses rapidly."

"So we need to be prepared in advance for intracranial pressure management and cooling, to promptly respond to various possible symptoms and provide targeted treatment."

"Alright, I’ll go arrange it and connect him to a monitor. Teacher Liu, since you have some free time, could you talk to the patient’s family?" Xu Yino asked tentatively.

Liu Banxia looked at him, "My task today is to be cautious with my words, which is quite nice, saving a lot of effort. I had a greasy lunch, I should make some tea to drink."

Xu Yino sighed inwardly; why does this big demon king have such a strong desire for revenge?

If it were just the patient’s wife, she wouldn’t have hesitated, but the patient’s wife also brought a small child. Seeing their father’s situation might negatively affect the child.

But the big demon king didn’t plan to intervene, so she’ll have to face it head on.

Regardless, the patient’s family must be informed about the situation; he’s nearly reaching ICU criteria.

It’s okay to conceal some things from the patient with harmless lies, but there must be no deception with the patient’s family; all possibilities should be explained.

This is the standard process; don’t consider whether the patient’s family can accept it. Because saying too little now could lead to lawsuits in the future.

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