The Enhanced Doctor-Chapter 582 Acute Respiratory Distress Patients

(Thanks to Crushing Sorrow for the monthly ticket and encouragement.)

Liu Banxia was actually quite curious if Lin Chenglin had any success when he ran out in the middle of the night yesterday to win back his wife. But there was no way to call and ask, as this friend of his could be overly sensitive at times.

After a sweet breakfast with Qiaoqiao, he headed straight for the Second Affiliated Hospital’s Emergency Center.

Wang Xiaoyan and Jiaojiao didn’t join them; they were both happily sleeping in. They couldn’t compare to Liu Banxia and Qiaoqiao. Watch them display their affection? That would be asking for torment; sleeping in was true bliss.

"Had a good rest yesterday?"

As soon as he walked into the Emergency Center lobby, Shi Lei greeted him with a smile.

The others also smiled at him, looking like they were relishing his misfortune.

"I’d actually brought some teppanyaki for you all, thinking we could have it for lunch. Looks like I’ll have to enjoy it all by myself now," Liu Banxia said.

"No way! We have to eat it. Besides, don’t we need to contact those external parties? I’ve pretty much figured out the procedures now," Wang Chao said hurriedly.

"That’s more like it. Miao Rui, go get the food from the trunk. It’s all semi-prepared stuff I brought back yesterday; just a bit of cooking at noon, and it’ll be ready to eat." Liu Banxia handed the car keys to Miao Rui.

"Think about it. I finally get a day off, and what happens? I become a delivery guy. You all benefit, and I get nothing out of it."

"What can you do? It’s your day off," Shi Lei said with a laugh.

"Now that you’re back, I can relax a little. I really don’t want to relive being chief resident. Personally, I think we can start grooming Wang Chao and Qi Wentao for it ahead of schedule."

"Boss Shi, do you have to be so cruel? Fine, since there aren’t many patients right now, I’ll go study fecal transplantation," Wang Chao said, moving aside.

"Ah... he’s really been struggling these past few days, poring over research materials until late every night," Shi Lei said.

"There’s no way around it. I don’t know much about this field either, and I don’t have that much energy to help him with research. I can help him with the liaison work, but he’ll have to handle the actual procedures himself," Liu Banxia said.

"By the way, during morning rounds, how was our IgG4 patient? Has his abdominal pain subsided at all?"

"It won’t be that quick. It’ll take at least a few more days to see some effect," Shi Lei replied with a laugh.

"Are you worried we might have misdiagnosed the gallbladder and bile duct stones, and he’ll end up needing surgery to remove them? Don’t worry, it should be fine."

"By the way, Doctor Huang from Obstetrics asked me to remind you not to forget about coordinating the operating room schedule. I think the earliest one is due in about five or six days."

Liu Banxia nodded. "I got it. I’ll go change my clothes first."

He really had to coordinate this well. After all, the Emergency Center’s operating rooms were shared by the entire hospital to improve their utilization rate.

Just after he finished changing, Liu Banxia’s phone rang. It turned out to be Xu Hui. Liu Banxia glanced around the clinic.

"Brother Xu, where are you? Not in the consultation room?" Liu Banxia asked after answering.

"I’m in Ward 206. I have a patient here with a bit of a situation. You’re on shift, right? Come over and take a look for me," Xu Hui said.

"Alright, I’m coming right up," Liu Banxia said and hung up.

Liu Banxia didn’t delay. It was just on the second floor; taking the stairs was faster than waiting for the elevator.

"The patient is a 47-year-old male who came in yesterday afternoon with fever and cough. He’s had a cough for nearly a month and said he thought it was a cold," Xu Hui explained when Liu Banxia arrived.

"Upon questioning, he mentioned his cough worsens when exposed to irritant odors, even cooking fumes. He also experiences shortness of breath when cleaning at home, which improves with rest.

"This is yesterday’s chest X-ray, which shows right lower lobe pneumonia. Auscultation revealed distinct wheezing. Combining these findings, we diagnosed it as asthma secondary to pneumonia.

"We started him on anti-infectives, steroids, and bronchodilators. However, there was no significant improvement during this morning’s rounds, and his symptoms actually worsened a bit just now.

"His breathing has become more labored, and he’s feeling chest tightness. The wheezing is also more pronounced. We just drew blood for an arterial blood gas analysis. Given his current state, I’m not sure if we should secure his airway preemptively. We gave him oxygen a moment ago, and his breathing has improved slightly."

After listening to Xu Hui’s description, Liu Banxia took off his stethoscope and carefully auscultated the patient’s lungs. The wheezing was indeed prominent. Such sounds usually indicate bronchospasm in patients, a common sign of asthma.

He picked up the X-ray film from the side and glanced at it against the light. There was minor inflammation in the lower right lung, very minor. If not for the asthma symptoms, he wouldn’t have met the criteria for hospital admission.

Then he carefully examined the patient’s supraclavicular fossa, suprasternal notch, and intercostal spaces. All three areas showed retractions. There was no need for further deliberation; they had to secure his airway immediately.

"Intubate him and send him to the ICU. He’ll need a ventilator. We’ll discuss his condition later. His current status is poor; breathing is very difficult for him," Liu Banxia said.

"Doctor, what’s wrong with my dad? Does he have to go to the ICU?" asked the patient’s daughter, who was by his bedside.

"The patient is currently experiencing airway obstruction. This means that due to bronchospasm, he cannot inhale enough fresh oxygen to sustain life," Liu Banxia explained.

"We are transferring the patient to the ICU for closer monitoring. His condition hasn’t improved much despite the oxygen therapy. The only way to resolve his current difficulty is to deliver oxygen directly to his lungs via intubation.

"If he hadn’t shown signs of acute respiratory distress, Doctor Xu wouldn’t have called me for a consultation. The fact that he didn’t improve with steroid treatment suggests the bronchospasm might be caused by something else."

Before the patient’s daughter could speak, the patient lying on the bed weakly waved his hand and nodded.

For him, taking a full, easy breath had become a luxury.

Although the patient had nodded his agreement, Xu Hui still explained the approximate costs of ICU treatment. The decision to go to the ICU was Liu Banxia’s call, but explaining these matters to the patient’s family was the responsibility of the attending physician. If a patient was moved directly without explanation, it would inevitably lead to chaos when settling the bill.

"This progressed so quickly. What do you think might be going on?" Xu Hui asked as they walked towards the ICU.

"It’s hard to say. Let’s see how he is once we get to the ICU," Liu Banxia replied.

"Once his vital signs stabilize, let’s do a chest CT. Should we do a contrast-enhanced scan as well? And do we need to call someone from Cardiology to take a look?" Xu Hui asked.

"Yes, let’s do both plain and contrast-enhanced scans to check for things like a pulmonary embolism," Liu Banxia agreed.

"His condition is progressing very quickly. Was there a big difference in his presentation when you admitted him yesterday compared to your rounds this morning? Does he have any other symptoms?"

Xu Hui shook his head. "The difference wasn’t huge. It was mainly the acute respiratory distress that came on very suddenly. Those were all the symptoms I noted. He has no family history of allergies."

Liu Banxia nodded. Just then, they arrived at the ICU.

Zhang Zhiyuan, who had been notified, took over and immediately began working.

Once he was connected to the monitor, they were all startled—the patient’s blood oxygen saturation was only 85%. Any further delay could have been life-threatening.

After he was connected to the ventilator, the patient’s blood oxygen levels gradually began to rise, and his vital signs started to stabilize.

"What’s the situation? What’s his underlying condition?" Zhang Zhiyuan asked.

"Brother Xu admitted him yesterday; let him fill you in. He suddenly developed acute respiratory distress. Even though he has some asthma, this looks like it could be allergic," Liu Banxia said.

Xu Hui quickly recounted the patient’s situation to Zhang Zhiyuan and showed him the chest X-ray.

"So, what did you two decide to do? The inflammation on the X-ray doesn’t look too severe. So why is it causing such profound dyspnea?" Zhang Zhiyuan asked after reviewing it.

"We’re planning a chest CT, both plain and contrast-enhanced. I’ll go schedule it with the CT suite now and also update the patient’s family. You guys keep an eye on his vitals here," Xu Hui said.

Zhang Zhiyuan nodded.

"Brother Zhang, based on your experience, what do you think this is?" Liu Banxia asked.

"Looking at the blood work and the chest X-ray, there’s nothing particularly abnormal. If I had to guess, I’d say it’s pneumonia with asthma," Zhang Zhiyuan said.

"But the conflicting part is, steroids should have brought some improvement, yet his condition worsened. There should have been at least some effect, shouldn’t there?"

"That’s precisely the puzzling part. Otherwise, Brother Xu wouldn’t have been so worried," Liu Banxia nodded.

"Are you people even competent? Why so many tests? The anti-infectives and steroids didn’t work, so why are you still using them?" 𝒇𝒓𝙚𝒆𝔀𝓮𝓫𝒏𝓸𝙫𝓮𝓵.𝓬𝙤𝙢

Liu Banxia had barely finished speaking when they heard the patient’s daughter shouting from the doorway. He sighed internally; this could get complicated.

"Currently, we can’t give a definitive diagnosis. The patient’s symptoms are consistent with pneumonia and asthma, but symptomatic treatment hasn’t yielded a significant effect. That’s why we need to conduct further tests," Xu Hui said patiently.

"Our subsequent treatment will be determined by the latest test results. Please, try to recall carefully: has the patient experienced any other symptoms during this time?"

"Didn’t I tell you all this yesterday? He just started coughing badly this week and had some cold symptoms. Fine, do whatever tests you want! Just don’t bungle it," the patient’s daughter retorted.

"Please rest assured, we will definitely be thorough," Xu Hui assured her.

Seeing that Xu Hui had the situation under control, Liu Banxia remained silent.

One shouldn’t assume that jumping in with a few more words will help; it might just agitate the patient’s family further. Sometimes, these situations are best handled one-on-one.

It’s usually only when interns encounter such situations and don’t know how to respond that they need someone else to step in.