The Enhanced Doctor

Chapter 1264: Chapter 1264: Tetanus

"Use your strength to open your mouth, use all your might."

Rushing to the bedside, Liu Banxia said nervously.

The patient tried hard, but his mouth didn’t open wide.

"Director Liu, what’s wrong? Is it a stroke?" the patient’s wife asked worriedly.

"Hold on, let me check his neck," said Liu Banxia.

After speaking, Liu Banxia reached behind the patient’s neck. Feeling the tense neck muscles, he sighed internally.

"Go get a tetanus immunoglobulin," Liu Banxia said solemnly.

Upon hearing his words, Liu Yiqing was stunned but still turned and ran out.

She hadn’t expected the patient to have tetanus, which explained why he couldn’t open his mouth. One of the symptoms of tetanus is spasms, often affecting the jaw muscles first.

"Director Liu, is this... is this tetanus?" the patient asked, panicked.

Liu Banxia nodded, "Judging by your symptoms, it should be tetanus. Didn’t you say you pierced the blister with a needle? Not a sewing needle?"

"It was a sewing needle, I just poked a hole to let the fluid out. I even left a piece of thread. Isn’t that what everyone does?" the patient replied.

"Think carefully, was there rust on the needle, or was the thread dirty, with soil or similar?" Liu Banxia continued.

"I really didn’t notice. Director Liu, am I going to die?" the patient asked nervously.

"Your symptoms are indeed typical of tetanus, so I have to send you to the ICU," Liu Banxia said.

"Tetanus causes muscle spasms, and the bacteria can produce toxins affecting the central nervous system. We need to detoxify and neutralize the free toxins."

"Our advantage is that we caught it as soon as you showed symptoms. If we treat it symptomatically, there shouldn’t be much issue, but the treatment process will be lengthy, so be prepared mentally."

"By the way, how many days has it been since you pierced the blister? You shouldn’t have misremembered this, right?"

Liu Banxia hoped for a good answer to this question.

"Must be six or seven days," the patient said.

"I remember now, didn’t you use the needle from the balcony?" the patient’s wife suddenly asked.

"Yes, that needle. I was resting on the sofa, saw the needle there, and just pierced the blister," the patient said.

"Your son was poking soil in the flower pot with that needle," the patient’s wife said.

"Don’t panic yet, hold on, the situation is still ideal," Liu Banxia quickly reassured.

"The first advantage, we noticed it right at the onset. The second advantage stems from the nature of tetanus; the sooner it occurs, the worse the prognosis."

"He has already had a week of incubation period, which is ideal. Keep a positive mindset and we’ll first administer the tetanus immunoglobulin, which is a specific remedy."

"But because the toxins have impacted the central nervous system, we need to detoxify slowly, which will take time. I’ll discuss this later with the ICU to decide whether to admit you there or provide special care here."

"Director Liu, so he won’t die?" the patient’s wife asked.

"Generally, there shouldn’t be much of a problem; I’ll call someone for a consultation. Don’t worry, I’m here. This is nothing to be afraid of; since we found it, we can handle it."

The patient nodded nervously, with sweat pouring from his forehead.

"Teacher Liu, tetanus immunoglobulin. Teacher Xu is behind, I invited him directly," said Xu Yino, who ran back.

"Do a sensitivity test first, and inject if negative," Liu Banxia said, then looked at the patient’s wife:

"This condition isn’t very complex, so don’t be overly concerned. Even though the illness lasts long, we are in the hospital."

The patient’s wife nodded, anxiously watching her husband lying on the bed.

"Director Liu, tetanus?" At this moment Xu Hui also entered.

Liu Banxia nodded, "He pierced the blister on his foot himself, turning into diabetic foot. The needle might have been contaminated. He just had jaw muscle spasms and neck stiffness, I diagnose it as tetanus."

"Should I call the ICU staff over? We are currently doing the tetanus immunoglobulin sensitivity test, do we need other medications?"

"Did you perform the debridement?" Xu Hui asked in return.

Liu Banxia nodded, "He consulted yesterday, and I did the debridement."

"That’s still relatively good. If your debridement is thorough, you can completely eliminate the pathogens. The symptoms right now are caused by the free toxins," Xu Hui said.

"He needs to be isolated, with reduced light, noise, and other stimuli. It’s safer to send him to the ICU, but since the ICU has a lot of equipment, you could also call someone from the ICU over to discuss."

"As for medication, it’s tetanus immunoglobulin, and then penicillin, which targets the wound."

"Inject tetanus antitoxin serum around the wound for a circular infiltration block. It’s best to use all the possible methods now."

"Let me think, also sedatives and muscle relaxants. Administer these directly. Spasms are likely to occur next, and medicating him will make it more comfortable and safer for him."

"Liu Yiqing, contact the ICU and see who’s available to come over," Liu Banxia nodded and said.

Liu Yiqing quickly pulled out her phone and called the ICU.

"It’s still quite fortunate. The most dangerous part of tetanus is the infection site. Don’t worry too much; our Director Liu’s debridement is the best in our entire Second Hospital," Xu Hui said, giving a thumbs-up.

He also needed to console the patient and his wife, as the mortality rate for tetanus is high, around 30%. The debridement done by Liu Banxia is quite good, reducing the toxin impact to some extent.

"Teacher Liu, the sensitivity test is negative." At this moment, Liu Yiqing reported.

"Good, proceed with the injection," Liu Banxia nodded.

"Director Liu, you were looking for me?"

Su Hongbo also walked in.

Liu Banxia quickly briefed them again on the patient’s condition. When it comes to treating and caring for tetanus patients, they are the most experienced.

"If you have a room available, and can monitor here, then you don’t need to send him to the ICU," Su Hongbo said after listening.

"However, this room won’t do. It needs to be set up as an isolation area. Place him in the empty room at the other end of your corridor. Reduce any stimuli like light and sound sources; isolation at the other end will be quieter."

"In addition, treat symptomatically; you’ve given tetanus immunoglobulin, and sedatives and antispasmodic drugs are being prepared. There’s nothing else necessary."

"The nursing care needs to be vigilant, adjusting medication dosage according to his symptom progression. Especially monitor his lungs and respiratory muscles, as these areas are most likely to have issues."

"If it progresses to severe tetanus with frequent spasms, administer 0.25% sodium thiopental slowly via IV push, but this is only temporary and emergency handling."

"The challenge with this patient is his diabetes. During the entire treatment process, he’ll consume a lot of energy due to spasms, so high-nutrition supplements are needed routinely."

"Adjust according to his actual condition. If feasible, he can stay in the ward for treatment because we also use these plans in the ICU."

"How long is the expected treatment time?" Liu Banxia asked.

"Three to four weeks, but he might recover faster. Since you’ve completed the debridement, it might be around two weeks if he improves well enough."

Liu Banxia frowned. He knew it would take some time to fully heal from this illness. But planning for a month would require a lot of effort from the second department.

Currently, there aren’t many patients in the second department. Once this patient’s monitoring is hooked up, connecting the alarm should also be fine.

"Alright, we’ll keep him in our second department," Liu Banxia said after thinking for a while.

"The room at the end of the corridor will be the isolation area. If we send him to your ICU, handling him there would also be troublesome. I’ll arrange for a doctor to regularly check on his status."

"His wife is here too, and if symptoms progress, she can notify us promptly. Liu Yiqing, please arrange it now. Get that room prepared and then transport him."

"This arrangement is good. The main thing is to closely monitor the lungs and throat. Throat spasms can easily affect breathing. If the lungs develop an infection, it’s the hardest to deal with."

"We’ll have to judge if a tracheostomy is necessary based on his condition, as there’s no fixed standard at the moment."

"I did an auscultation when he was admitted yesterday; his lungs were fine. I just listened again, and his heart and lung sounds are good. Let’s also get a CT scan for better assurance."

Su Hongbo nodded; it’s the same approach even if sent to the ICU.

The ICU has a high patient density; unexpected stimuli could trigger spasms. The toxins affecting the central nervous system are quite troublesome.

While it’s a small consultation with just the three of them, such treatment plans are standard everywhere.

The key is the subsequent nursing care. If pneumonia arises, it would be distressing.

As Su Hongbo mentioned, there’s no standard to determine when a tracheostomy should be performed.

Even in ordinary cases, tracheostomy carries high infection risks. This patient also has diabetes, complicating tetanus treatment due to diabetes.

Staying in the second department helps reduce ICU pressure. Another reason was forgetting to inquire about a patient during yesterday’s admission.

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