Chapter 1132: Chapter 1132: Rapid Deterioration of Symptoms
"Teacher Liu, my patient woke up. He’s a fitness enthusiast, and both his CT and echocardiogram are negative."
As soon as she got back to the emergency center, Liu Yiqing came trotting over.
"What’s his heart rate?" Liu Banxia asked.
"His heart rate has gone up to 51. Do we need to medicate? Considering he’s a fitness enthusiast, is that heart rate acceptable?" Liu Yiqing said.
"Keep observing." Liu Banxia nodded.
"He’s had symptoms for three days, same as today, just not as much vomiting as today. I just checked his temperature again, it’s still 38.2 degrees." Liu Yiqing said quickly.
"Oh right, he also had diarrhea. Very mild though, only happened yesterday. His serum sodium in the electrolytes is a bit low, we’ve already given him glucose–sodium chloride solution."
"Then give him some mannitol as well, safer that way. Huang Bo, how’s your patient doing?" Liu Banxia called out.
"Teacher Liu, my patient’s results just came back. His serum potassium is a bit low, it’s moderate hypokalemia." Huang Bo said.
"OK, then we’ll just correct it with IV potassium. You’ve done your homework on the dose and infusion rate, right?" Liu Banxia asked.
Huang Bo nodded with a smile. "Teacher Liu, don’t worry. Let’s get his potassium up first and see."
With these two patients’ situations more or less sorted for the moment, Liu Banxia truly relaxed.
Whether it was bradycardia in Liu Yiqing’s patient, or muscle weakness with seizures in Huang Bo’s, if they couldn’t find the cause, the patients’ symptoms would get very complicated.
Liu Yiqing’s patient has hyponatremia, which can cause headache, nausea, vomiting, fatigue, and can also lead to bradycardia.
The patient is a regular fitness buff, so his heart rate should be lower than the average person’s. Add the influence of these symptoms, and the way he looks now fits.
Huang Bo’s patient has hypokalemia.
Not long ago they had just dealt with a patient with severe hypokalemia, and for that patient he’d gone over the precautions for potassium supplementation in detail with this whole group.
Hypokalemia alone can explain this patient’s current condition; you could say it’s the same disease manifesting differently in different people.
That previous severe hypokalemia patient only went into ventricular fibrillation after he learned about his own condition; during the exam he still seemed perfectly fine.
These two patients also highlight how important blood tests are, otherwise they’d just be groping in the dark.
"President Qi, take everyone to eat. Brother Wei and I will keep an eye on things here." Liu Banxia walked over to Qi Wentai.
"I don’t know what’s going on today, it’s like everything came together at once. This is the first time our emergency center has had so many flu patients, it’s as busy as a major resuscitation task." Qi Wentai said.
"It’s just this wave. For flu patients there really aren’t many treatment options anyway, it’s mainly symptom relief." Liu Banxia said.
Qi Wentai nodded. There was no need to stand on ceremony; when it’s time to eat, you eat.
After taking over the shift, Liu Banxia and Wei Yuan also became very busy.
But like he said, flu might be a minor illness, yet you really can’t cure it on the spot. All you can do is relieve symptoms, adjust their electrolyte balance, and make them a bit more comfortable.
They stayed busy until after two in the afternoon before they finally finished dealing with all the patients for the day.
Of course, if trauma patients came in, they would still need ongoing treatment.
"Director Liu, they’ll be bringing in a comatose patient in a bit. Before losing consciousness there were symptoms of ataxia and delirium." the triage nurse called out.
"How old is the patient?" Liu Banxia asked.
"Twenty-eight. He collapsed at work after lunch." the triage nurse said.
"Alright, I’ll take him." Liu Banxia nodded.
"Teacher Liu, we’re back from lunch." At this moment Liu Yiqing came running back, all bouncy.
"There’s not much going on now that you’re back. Keep an eye on your patient, and get some rest—you’re on duty tonight." Liu Banxia said.
"Honestly I’m really not that tired. Even though triage just now was a bit hectic, it’s still a lot easier than being on the operating table." Liu Yiqing said.
"If you’ve got the time, sort out the data on the patients you’re in charge of, and go over the upcoming surgeries carefully. That way, when you’re scrubbed in again, you’ll know exactly what you’re doing." Liu Banxia said.
"Teacher Liu, did you ask the director? When are we going to set up General Surgery Ward One and Ward Two?" Liu Yiqing asked.
"How would I know? And it’s not really my place to ask, is it? It’d look like I’m trying to grab power for myself." Liu Banxia said.
"Then what were you doing with the director this morning? You usually don’t wander into his office." Liu Yiqing asked curiously.
Liu Banxia rolled his eyes. "I had legitimate business, didn’t you hear Xu Yino say?"
Liu Yiqing shook her head blankly. "We were so busy with admissions today, there wasn’t even time to chat."
"Alright then, you’ve just finished eating anyway. I’ll give you two ten minutes to chat and rest. Go play, I’ve still got patients to see." Liu Banxia said.
The nurses nearby all started laughing along.
Among the six little ones, the most adorable is Dr. Liu Yiqing, the kind of goofy cute.
Just then the ambulance pulled up at the entrance, and the paramedics pushed a gurney inside.
"Vital signs are stable. After lunch he developed ataxia and delirium, then fell into a coma after arguing with someone," the paramedic said.
"Put him on the exam bed. Su Wenhao, do the physical," Liu Banxia said.
"Director Liu, how come you’re the one taking admissions today?" the paramedic asked curiously.
"We’ve had a bit of a spike in flu patients today. I just finished dealing with them. President Qi and the others haven’t come back from lunch yet," Liu Banxia said.
"Yeah, we took two post-flu coma patients over to the municipal hospital too. Today has been crazy busy. No idea when this wave of flu will finally ease up," the paramedic said.
Liu Banxia paused for a moment, a little surprised that other hospitals were seeing the same thing. But he didn’t dwell on it. Once flu takes off, it really can progress very fast.
Especially now that it’s cold, people mostly stay in enclosed spaces, which naturally bumps up the infection rate.
"Teacher Liu, blood pressure 120/90, heart rate 90, temperature 37.8°C, mild rales on lung auscultation. Plan: mannitol to prevent cerebral edema, and order CBC, blood biochemistry, and chest and head CT," reported Su Wenhao after finishing the exam.
"Alright, let’s do that. Follow him and keep an eye on how he’s doing," Liu Banxia said.
Su Wenhao led the team and got to work.
By protocol, this patient should have had a chest X-ray first, but that would have meant queuing twice and wasting a lot of time.
So Su Wenhao decided to do a CT of the head and chest together, to save time.
After all, this was a patient brought in by ambulance. Even if it didn’t quite reach the level of a full emergency, they still couldn’t afford to waste time.
"Doctor, is Liu Dong in danger?" a colleague who had come with the patient asked.
"We’re not sure yet. We’ll have an answer once the brain CT is out," Liu Banxia said.
"Have you contacted his family? If you have his ID card, go ahead and get him registered first. In his condition he’ll have to stay in the hospital for at least a few days."
"We have his ID card; we found it at his workstation. What illness is this? Did he get so angry from the argument that he collapsed?" the colleague asked cautiously.
"Strictly speaking it wasn’t really an argument, more like some disagreement during a chat. Usually he’s totally fine. We don’t know what happened today—his speech was all jumbled,"
Liu Banxia smiled. "So his disagreement was with you?"
The friend of the patient nodded, embarrassed.
"Don’t worry for now. A primary illness is more likely," Liu Banxia said.
"If it was a heart attack or stroke brought on by anger, he wouldn’t be presenting like this. Medically speaking, this combination of ataxia and delirium is a symptom complex, which suggests something going on in the ventricles. Has he had any other symptoms these past few days?"
The colleague thought for a moment, then shook his head. "No, everything’s been normal. Just a bit of nasal congestion and runny nose, his voice more nasal, and he’s been sweating a lot."
"Probably the flu too. He said he might’ve gotten chilled when he showered a few days ago, but it should almost be better now. It’s already been five days. He... Doctor, is this condition dangerous?"
Seeing Liu Banxia’s brows knit together, the colleague was startled.
Liu Banxia shook his head. "Something just feels off. We’ve already had three flu patients today with atypical presentations, and there are two more over at the municipal hospital."
"In his case, it might very well be hyponatremia or hypokalemia causing it. Try to recall carefully—any other symptoms at all?"
The colleague racked his brains for a while, then still shook his head. "No other symptoms. We were even joking around at lunch. He said he had to eat more so the flu would clear up faster."
"He also said the flu really made him feel awful—that everything tasted bland. He usually loves barbecue, but when we went two days ago he didn’t enjoy it like before."
"Alright, go get him registered first," Liu Banxia nodded.
Having symptoms like this after the flu isn’t unusual; it just meant this patient’s case was on the more severe side.
Still, there was a lingering uneasiness in his mind. Were there more patients than usual today slipping into coma from severe flu?
It looked like they really needed to stay on high alert with this wave of flu, especially the staff in the emergency center—they had to be extra vigilant.
With that thought, he shared his concerns with everyone, telling them to be careful about protection during admissions and to increase the frequency of disinfecting public areas.
No telling how long this wave of flu would last. If the emergency center staff themselves went down, the workload would be brutal.
"Beep-beep-beep... beep-beep-beep..."
Just after he finished arranging things, he heard the monitor alarm go off. He turned and saw that it was Huang Bo’s patient, and Huang Bo was in the middle of intubating.
Liu Banxia’s heart sank. This was respiratory failure, likely respiratory muscle paralysis caused by hypokalemia.
But that shouldn’t be happening. How could the condition suddenly deteriorate this fast?
Comments