The Enhanced Doctor

Chapter 1281: Chapter 1281: Each Has Their Own Specialty

"Administer oxygen, prepare for intubation."

Liu Banxia shouted.

Without hesitation, Su Wenhao quickly began operations with the nurses to prepare for intubation.

Liu Banxia didn’t remain idle either, starting to auscultate the patient.

The patient is now in respiratory distress and sweating profusely, which he diagnosed as a pulmonary embolism.

This was also a diagnosis Su Wenhao had considered; he just didn’t anticipate the patient’s condition deteriorating so rapidly.

However, his brow was tightly furrowed because the patient’s labored breathing was interfering with his auscultation.

The only thing that could be confirmed was that the breath sounds were symmetrical, indicating no atelectasis or pneumothorax. Given the current situation, this could be seen as good news.

"What symptoms did the patient have just now?" Liu Banxia asked.

"Just an infusion, everything seemed fine, and then this happened suddenly," the nurse said nervously.

"Don’t worry, this isn’t an allergic reaction. Intubate immediately, let’s keep the patient breathing, and discuss other matters later," Liu Banxia reassured.

Su Wenhao, who was ready, quickly went to work.

Being a core member of the emergency reception team, he was experienced in procedures like tracheal intubation and chest tube drainage. Without losing any time, he completed it and connected the ventilator.

"Teacher Liu, it’s done. Blood oxygen levels are rising to 90%," Su Wenhao reported.

Liu Banxia’s expression didn’t relax; instead, he intently focused on the ECG monitor.

After more than two minutes, Liu Banxia spoke up, "Contact the family and call the cardiologist over."

Su Wenhao nodded vigorously and hurried to get help.

He had also noted the issue: the patient’s blood oxygen had stalled at 94%, which was unusual.

Currently, the patient is on a ventilator receiving pure oxygen. If there were no issues, the blood oxygen should reach 98% or 99%, even if not 100%.

But being stuck at 94% indicates a problem with the patient’s respiratory system.

"Director Liu, is it a pulmonary embolism?" Xu Guosheng arrived swiftly.

"Auscultation doesn’t sound like pneumothorax or atelectasis, and I didn’t notice anything unusual in the heart sound either. Although the bilateral breath sounds are slightly weak, I’m inclined to suspect a pulmonary embolism. Could you perform a heart ultrasound?" Liu Banxia asked.

Xu Guosheng glanced at the ECG monitor: blood pressure 100/70, heart rate 120, respiration 35, blood oxygen saturation 94%.

"Run an ECG and do an arterial blood gas analysis. From what I see, there’s definitely something wrong with the respiratory system; it’s likely a pulmonary embolism, otherwise, we wouldn’t see low blood oxygen and tachypnea," Xu Guosheng stated.

"However, I’m puzzled; the patient just has pneumonia, no fractures of long bones, no symptoms of varicose veins in the lower limbs, and no history of prolonged bed rest. How could this pulmonary embolism have occurred?"

"Were troponin and cardiac enzyme levels checked?" Xu Guosheng asked.

"Yes, they are normal," Liu Banxia replied.

"In such cases, it could be due to debris from myocarditis or endocarditis causing a pulmonary vascular embolism," Xu Guosheng suggested.

"Ah, the deepening of lead I, and the appearance of Q/q waves and T-wave inversion in lead III, align with signs of high right-sided heart pressure load."

"Given the current situation, doing a CT scan is too risky; let’s do a heart ultrasound first to see what’s going on. Otherwise, we might have to send the patient to the ICU first; the likelihood of a pulmonary embolism is quite high."

Liu Banxia nodded.

"Director Liu, we’ve also contacted the family. They should arrive in about ten minutes," reported Qi Wentai, who had arrived.

"Alright, let’s check the heart ultrasound results first. Although the odds of pneumonia causing a pulmonary embolism are low, it’s not impossible," Liu Banxia said.

Xu Guosheng, though not a professional ultrasound doctor, deals with such cases daily and focuses on specific aspects during patient examinations.

"The right ventricle is enlarged, and pulmonary artery pressure is elevated, but no embolus was seen in the pulmonary vessels nor any debris on the heart," observed Xu Guosheng during the examination.

"What do you think? Proceeding to CT scanning now is quite risky," Liu Banxia stated.

"Based on my experience, it’s a pulmonary embolism. Let’s discuss thrombolysis directly with the family once they arrive," Xu Guosheng concluded.

"Even though the lungs are supplied by multiple vessels, given the patient’s severe condition, and not knowing if it will worsen further, we can’t take that risk."

"Moreover, the patient’s blood pressure is somewhat low; if it drops further, medication will be needed to raise it. We should investigate the precise cause of the pulmonary embolism since the recent heart ultrasound showed clean vessels."

"Let’s review it thoroughly, just in case there’s something very small we missed. If necessary, we must consult an ultrasound specialist."

After saying this, Xu Guosheng carefully resumed his examination.

Liu Banxia and the others also focused intensely, but found no additional information.

"We have no choice; our skills are not deep enough. Should you call, or should I?" Xu Guosheng asked.

"You better call; you usually have closer contact. This patient is indeed unsuitable for movement right now, unless sent to the ICU." Liu Banxia said.

Xu Guosheng nodded with a smile and then got in touch with the ultrasound department.

Each field has its specialization; they are professionals who deal with these examinations. What looks normal to everyone may reveal issues to an experienced eye.

"Let’s wait; they’re checking now." Xu Guosheng said after hanging up the phone.

"What do you think is causing this?" Liu Banxia asked.

"Hard to say, but inclined to think it’s vegetations caused by endocarditis or myocarditis dropping off. However, nothing was seen during the earlier examination, which makes it challenging to handle." Xu Guosheng replied.

"Considering the current situation, we still have time as the blood oxygen level is hanging at 94%. This leaves us with plenty of time."

At this moment, the patient’s parents also arrived, and Su Wenhao naturally took on the responsibility of receiving them.

As the main attending physician, he had to do this task himself.

The elderly couple was quite affected by their son’s current state. They authorized full treatment efforts; their two daughters would come later, and they had enough money.

After a few more minutes, Chen Bin from the ultrasound room arrived.

"Old Chen, we still need you to take a look; we can’t be sure." Xu Guosheng said.

"I might have difficulty too; you guys almost check daily as well." Chen Bin replied.

"We can’t do it; neither I nor Dr. Xu have confidence. It’s up to you now, and only then can we finalize the treatment plan." Liu Banxia said.

He wasn’t just offering compliments; understanding the cause of the pulmonary embolism was essential for appropriate treatment. A thrombus formed by blood clots and one formed by vegetations are entirely different concepts.

A thrombus formed by blood clots can be treated with thrombolytic drugs. But vegetations? No matter the dosage of thrombolytic drugs, it won’t help. You could even cause brain hemorrhages in the patient and see no effect.

Because that kind of vegetation is a bacterial mass, which can’t be treated with thrombolytic drugs.

Chen Bin sat by the diagnostic bed and began to examine the patient carefully.

"Teacher Liu, the patient’s blood pressure has dropped a bit." Su Wenhao said.

"Keep observing; if it continues to drop, administer some Noradrenaline." Liu Banxia replied.

He was also monitoring the patient’s blood pressure, which was currently within an acceptable range.

"Found it; see, it’s right here. Though it’s quite small, it is a thrombus that hasn’t completely blocked." Chen Bin suddenly called out.

"Arterial embolism. Now let’s see if it fell off from the heart. Estimating the vegetation will be very small, which will make this challenging."

"Is it really endocarditis?" Liu Banxia asked in surprise.

"Almost certainly; this situation fits well. But I need to check carefully, examining bit by bit." Chen Bin replied.

He himself was sweating a bit; detecting it had not been easy. It’s a summary of years of experience; otherwise, it would be tough to spot.

"Please check the mitral valve closely; anyhow, I feel something’s not quite right. It should be endocarditis, no doubt about it."

After examining for another while, Chen Bin pointed at the screen.

Indeed, it was a very small vegetation, even if viewed closely, it required two or three looks to catch its trace.

By now, the patient’s situation was clarified. Caused by endocarditis; luckily, we didn’t immediately thrombolize earlier. Otherwise, it would have been pointless and could pose dangers to the patient.

Yet, for the patient, the current situation wasn’t so favorable either.

Endocarditis is challenging to treat. The best we can do first is cultivation, then consider medication, all leading to an ICU transfer.

Su Wenhao hurriedly updated the patient’s parents on the latest situation, about the ICU transfer, as the costs would be much higher. Moreover, with the current condition, there’s a risk of it suddenly becoming more severe.

"Sigh... truly impressed, professional matters need professional people to handle." Liu Banxia said with emotion.

"Don’t praise me; I do numerous checks daily. You guys only check a few? If you were in my position, you would definitely be more skillful." Chen Bin replied.

"Next, it’s your turn to do your part; identifying which bacteria is causing this is most important. If we can eliminate the bacteria, perhaps there’s no need to replace the mitral valve?"

Xu Guosheng nodded, "Almost, let’s try medication first. If it works, we can consult Director Chen then; it’s his area."

"Or Director Liu could go straight ahead; honestly, I’d love to see Director Liu performing heart surgery. I’m curious about what surprises it might bring us."

"Forget it; I don’t have that ability now." Liu Banxia said with a bitter smile.

He used to be confident, but as a non-beginner now, he knows he’s quite lacking in this area.

"Teacher Liu, please come over and have a look."

While changing the patient’s hospital gown, Su Wenhao called out in a tense voice.

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