Chapter 1443: As Expected, Something Was Overlooked

Chapter 1443: Chapter 1443: As Expected, Something Was Overlooked

Rushing to the patient’s side, Xu Yino first checked the color of the patient’s blood to determine whether it was hemoptysis or hematemesis.

Seeing the blood was bright red with mucus and bubbles, she felt somewhat relieved; it was hemoptysis. In the case of hematemesis, the blood typically doesn’t have bubbles and mucus mixed in.

If it was hematemesis, it would mean the patient’s condition had suddenly become very severe.

"How are you feeling?" Xu Yino asked.

"Uncomfortable, even more uncomfortable than just now," the patient said.

"Don’t be afraid; it’s hemoptysis. It’s just that during your severe coughing, the capillaries ruptured," Xu Yino explained.

"Now that you’re no longer coughing and there’s no further hemoptysis, it proves that coagulation has successfully occurred. Do you have any new sensations now, anything different from when you first came here?"

The patient shook her head and replied, "Now it just feels like I’m a little hot again, and my mouth is a bit dry."

Xu Yino hurriedly checked her temperature, which had dropped not long ago but now rose again to 38.2 degrees Celsius.

"Teacher Liu, should we start monitoring and contact the family?" Xu Yino asked.

Liu Banxia nodded, "Contact them. If it’s mere pneumonia, it’s rare for hemoptysis symptoms to occur."

"OK, connect the ECG, conduct tuberculosis screening," Xu Yino stated.

Liu Banxia remained expressionless on the surface but felt quite pleased inside.

Xu Yino reacted quickly, not needing any reminders from him, as she thought of these aspects herself.

Among the possible causes of hemoptysis, the most common are bronchiectasis and tuberculosis. In the patient’s chest CT, if there was indeed bronchiectasis, it would generally be visible.

Thus, a thorough investigation for tuberculosis is needed, even though the patient’s physical signs don’t appear obvious; it’s necessary to rule it out clearly.

Moreover, due to the recent episode of hemoptysis, it indicates the patient’s condition has progressed, so blood tests are also required.

Even though the patient will suffer a bit, it allows the doctors to have the most current understanding of her physical condition.

Although the patient’s condition has changed, after ruling out hematemesis, Liu Banxia did not directly intervene.

The concern for hematemesis is due to the possible risk of upper gastrointestinal bleeding. He has dealt with such patients before, and even endoscopic hemostasis is challenging.

After some busy work, observing the blood oxygen displayed on the ECG monitor made Xu Yino feel slightly relieved.

Currently, the patient’s blood oxygen saturation index is quite good, and according to recent inquiries, she does not have symptoms of dyspnoea or chest tightness, so the risk of acute respiratory failure seems minimal.

However, vigilance cannot be relaxed now; further investigations are still necessary.

After waiting a little longer, the urgent blood test results came back. Seeing the results, Xu Yino was somewhat puzzled.

The test results not only showed a low white blood cell count but also revealed a low platelet count, which explains why the patient experienced hemoptysis.

With such a low platelet count, it’s very easy for severe coughing to rupture blood vessels in the lungs, causing bleeding.

Now, a new question arises: what is causing the patient’s platelet count to decrease?

Similar to the patient’s decreased white blood cell count, it may be due to a severe infection. In this scenario, the decreased platelet count could also be caused by the infection.

However, both Xu Yino and Liu Banxia feel it’s not that simple.

The onset of the patient’s condition is quite sudden; if it were truly severe pneumonia, it should have reacted a few days earlier.

This brings them back to the original suspicion: does the patient have a hematologic disease like leukemia or lymphoma?

"Teacher Liu, should we perform a bone marrow aspiration?" Xu Yino asked softly.

"This question requires your judgment," Liu Banxia replied.

"Currently, you are her main attending physician, so you need to grasp her condition. Actually, I don’t have a better plan right now; consider it yourself."

Xu Yino hesitated for a moment, then nodded, "Let’s wait a bit longer; I’ll carefully inquire with the patient again."

After speaking, Xu Yino lifted the curtain and walked inside.

Liu Banxia rubbed his face; he couldn’t fully grasp this patient’s situation.

Given the information he has so far, the most likely cause is still pneumonia, but tuberculosis, leukemia, and lymphoma can’t be ruled out; these three need investigation.

Bone marrow aspiration is relatively quick, but it can subject the patient to further harm.

This is why he didn’t give Xu Yino a definitive answer earlier; procedures like lumbar puncture and bone marrow aspiration, invasive tests, must be handled cautiously.

In less than ten minutes, Xu Yino came out, her expression a bit peculiar.

"What’s up? Can you make a diagnosis?" Liu Banxia asked.

"Uh... Teacher Liu, the patient is experiencing hair loss," Xu Yino said.

"What do you mean?" Liu Banxia asked curiously.

"Just hair loss, the patient started losing hair over the past month, though she used to have pretty good hair volume," Xu Yino replied.

"Oh, looks like you want to test me, huh?" Liu Banxia laughed.

"But just from this situation, I still can’t make a judgment. Because many factors can cause hair loss, like poor sleep, stress—these are all possible."

"Ugh... let’s add one more thing. The patient is not just feeling fatigue; she actually has joint pain mixed with muscle soreness, making it difficult for her to differentiate," Xu Yino continued.

"Interesting, hair loss is mostly related to endocrine and immune system diseases, and now there’s joint pain," Liu Banxia said.

"Combined with the patient’s other symptoms now, both the white blood cell count and platelet count are decreased. Personally, I lean more toward rheumatic immune diseases."

"Have you done a physical examination? Are there any rashes on the patient’s body? If there are, then do a systemic lupus erythematosus screening. Given her age and symptoms, the likelihood of this disease is still quite high."

"Ugh... this is so frustrating. I’ve worked so hard, yet you identified it based on just these two points," Xu Yino said with frustration.

"The patient indeed has rashes, located on the chest. But the patient didn’t consider hair loss a symptom, and the limb soreness made her forget about joint pain."

"I’ve arranged for a quick screening for systemic lupus erythematosus. I took a look at the face myself but didn’t find any rashes."

Feeling a bit gloomy again, Liu Banxia made the judgment with just this little hint. And the judgment aligned with mine.

And me? After how long I’ve tried, it’s only now that we’re getting some clues.

"The upcoming treatment is key, you can’t be careless."

After saying this, Liu Banxia strolled over to another side.

Now that the diagnosis has reached this extent, it’s up to Xu Yino to consider the rest.

If she can’t handle the follow-up situation, then we might have to treat the folks at the emergency center to chicken legs.

But don’t think diagnosing is the end-all be-all. The patient’s symptoms currently align with the active phase of systemic lupus erythematosus, which is very dangerous.

Looking at the patient’s symptoms now, the condition is already affecting the skin and mucous membranes, bones, and muscles.

Rashes, hair loss, whole body soreness and weakness, joint pain—these are manifestations of these two impacts.

However, this disease can further affect the body, like the heart, respiratory system, kidneys, nervous system, blood system, digestive system, etc., all possibly becoming very dangerous.

If these symptoms start appearing one after another, we might have to push the patient into the ICU.

This is no joke, there are many aspects to consider and adjust.

But the emergency center has also treated patients with systemic lupus erythematosus before, so Liu Banxia isn’t worried that Xu Yino can’t handle it.

It’s actually a meticulous task; resolving issues as they arise.

"Congratulations, this is really remarkable. Would you say Xu Yino has graduated here? Though it seems a bit off track, kind of inheriting your path, right?" Wei Yuan asked with a smile.

"Haha, that’s really the case. But I won’t admit it was my influence, she just takes her work very seriously and responsibly," Liu Banxia laughed.

"But the next stage is key, let’s see if she can handle it on her own. If she seems all over the place, I’ll have to take over."

"I think it’ll be fine. She’s very meticulous. She’ll consider all situations, but now I have a concern," Wei Yuan said.

"Concerned about what?" Liu Banxia asked curiously.

"Concerned that other departments might feel pressure. Now we’re even handling the rheumatic immune department’s cases. Even in our emergency center, it’s like stealing the internal medicine’s work," Wei Yuan said with a smile.

"Haha, there’s nothing we can do about it. Anyway, Brother Huan and Brother Hui wouldn’t mind these things," Liu Banxia said.

"That’s how our emergency center works, whoever gets to it comes to it. Plus, relatively speaking, our surgical reception is indeed much more relaxed compared to internal medicine."

Wei Yuan nodded, this statement isn’t off the mark.

The emergency center’s surgery compared to the inpatient surgery still has a large gap.

Even those patients who have been checked in local hospitals come here mostly heading towards the inpatient department.

Nowadays in the emergency center, the surgeons primarily work on emergency reception. Even Liu Banxia doesn’t have many elective surgeries currently.

Feeling quite delighted, getting a rough grasp on the patient’s condition without a consultation is a success.