CHAPTER 470: 470 CHILDREN WITH BREATHING DIFFICULTIES

(Thank you to my friends, Xibei Feilang Mihu, and readers 20170927164124999, 20191123092721288 for the monthly ticket encouragement)

The patient with sepsis still weighed heavily on Liu Banxia’s mind. The next day, after breakfast, he returned to the emergency department’s ICU.

"A new lung CT was done last night; the right lung is completely white," Su Hongbo said.

"It’s progressing much faster than we anticipated. I just finished speaking with the family, and we’ve put the patient on an ECMO machine. Tell the lab to hurry up, isolate the infectious bacteria, and find a sensitive drug."

"Currently, there are signs of heart, liver, and kidney failure. Although we’re trying our best to manage with medication, the effects aren’t very pronounced."

Liu Banxia frowned. Even though this progression was somewhat expected, it was happening far too quickly.

"Thank you for your hard work. Do your best to maintain the patient’s vital signs and buy us some more time," Liu Banxia said.

Su Hongbo nodded. "Of course. Using ECMO can buy more time. We just hope it’s a common bacterial strain; otherwise, it would be very dangerous."

"Also, regarding your patient with liver cirrhosis, his condition deteriorated somewhat yesterday afternoon. Tomorrow, you should discuss with the family whether to keep him in the ICU or transfer him to a general ward."

"It deteriorated so quickly?" Liu Banxia asked, astonished.

"His liver cirrhosis was already quite severe, and this laceration just exacerbated things. His general physical condition was also quite poor to begin with. Your initial prognosis wasn’t far off. However, that prognosis assumed the most ideal circumstances. This current progression is just typical for his condition," Su Hongbo elaborated.

"Okay, I’ll speak with the patient’s family in a bit," Liu Banxia said with a helpless expression.

Moving to a general ward essentially means they’d be waiting for the end. There’s no need to waste so much money in the ICU. This would also give the family their final moments together, even though this period will be even more heart-wrenching for them.

His situation was different from the sepsis patient’s. For the sepsis patient, once the infecting bacteria were isolated and a sensitive antibiotic was found, targeted treatment would yield immediate results.

And this patient? He needed a liver transplant.

That was the fundamental difference.

"Teacher Liu, why don’t I go talk to the patient’s family?" Liu Yiqing, who was by Liu Banxia’s side, spoke up.

"You? Can you handle it?" Liu Banxia asked.

Liu Yiqing nodded, her eyes firm.

"Alright, you contact them then. I’ll leave it to you," Liu Banxia glanced at her and gave his permission.

This kind of communication was a difficult task; even seasoned doctors found such conversations daunting.

"President Liu, Dr. Chen from Pediatrics is calling you over for a consultation." Zhou Qian approached him as soon as he returned to the Emergency Center.

"Okay, if anything comes up here, have them call me. I’ll go to Pediatrics first to take a look," Liu Banxia responded.

His heart felt heavy; it was undoubtedly another complicated case. Even though his relationship with Chen Hongyang had been mended, Chen Hongyang wouldn’t call him for a consultation over a common ailment.

"Dr. Chen, I’m here," Liu Banxia announced when he found Chen Hongyang.

"This case is complicated," Chen Hongyang reported. "A 9-year-old boy came in this afternoon with a nosebleed. He has a history of nosebleeds, as well as abdominal pain, pain when breathing, and insomnia."

"Upon examination during admission, we found the child’s nosebleed wouldn’t stop. After cauterization to stop the bleeding, we observed that his nasal mucosa was somewhat thin. Upon inquiry, we learned he had previously used fluticasone propionate for occasional symptoms of dyspnea, which is likely the main reason for the thinning of his nasal mucosa."

"It was at this point that his condition changed. The child started coughing violently and coughing up blood. Although I suspected it was due to reflux from the nasal bleeding, I still ordered a chest X-ray for him."

"The X-ray showed no signs of inflammation, pulmonary embolism, or cystic fibrosis. Now, the child’s temperature has risen slightly, and he’s experiencing dyspnea."

"Have his abdomen and heart been checked? Did you also perform a bronchoscopy?" Liu Banxia asked.

"A physical examination of the abdomen showed everything was normal. Heart auscultation was normal. We also performed a bronchoscopy. It was precisely because we didn’t see any bleeding points that we ordered the X-ray," Chen Hongyang explained.

"The blood test results showed a slightly high white blood cell count, which suggests some inflammation. Otherwise, he wouldn’t be having difficulty breathing, but I’m unsure what’s causing this inflammation."

"Doctor Meng, the child’s temperature has risen again! It’s 39.2°C now, and his oxygen saturation has dropped to 95%," a nurse hurried over just then.

Chen Hongyang rushed towards the patient’s bed, with Liu Banxia following.

"Doctor, he just had another coughing fit," the child’s mother said. "But this time there was no blood; it’s just that breathing has become more laborious for him."

"Let me take a look," Chen Hongyang said and began to auscultate the child.

Liu Banxia picked up the X-ray film from the bedside and began examining it on the lightbox.

The X-ray was clear, showing the lungs were normal, with no signs of inflammation.

DING! Mission Released: Breathing Difficulty in Child

Open Mission: Respond to a consultation request from Chen Hongyang of Pediatrics. The pediatric patient continues to experience dyspnea and a worsening condition, despite a chest X-ray showing no pulmonary inflammation. Further diagnosis is required. Task rewards will be issued based on the diagnostic results.

"We’ve started him on oxygen," Chen Hongyang said, approaching Liu Banxia after giving his instructions. "Elevated temperature and decreased oxygen saturation are not good signs. I’ve given Tylenol and ordered a CT scan. Even if we don’t want to do more tests, we have to."

Liu Banxia nodded. "This X-ray looks remarkably clear. I’m starting to wonder if this reaction could be caused by some lesion within the abdominal cavity."

"Let’s order an abdominal CT as well. The child’s temperature is rising so rapidly; I feel this condition is quite dangerous. The child has a history of abdominal pain, right? Could it be carcinoid?"

Chen Hongyang frowned. "Your consideration isn’t without merit, but the child is currently only exhibiting high fever and dyspnea. He has a prior history of abdominal pain. His skin color is currently normal, and he’s not reporting abdominal or chest pain now."

"Moreover, the child’s past medical history includes pain when breathing, so I’m still personally inclined to think it’s an issue within the thoracic cavity, specifically the lungs or bronchi. Should we wait and see? Wait for the chest CT results?"

Liu Banxia nodded. "That was just a random thought. The cases I’ve encountered these past two days have all been very complex. That idea just now... it’s not quite ’treating a dead horse as if it were alive,’ but it’s close."

"Sigh... your idea is quite plausible, and some symptoms do align," Chen Hongyang said with a bitter smile. "But a major difficulty we face in pediatrics is that the more instrumental examinations we do, the more pushback we get from parents."

"They feel that every examination is harmful to the child. We had actually planned to do a CT scan directly, but there were too many people waiting at that time, so we switched to an X-ray."

Liu Banxia understood this point well. If the parents themselves had to endure such suffering, they might not care too much. But when it comes to their children, it becomes an enormous issue.

Their emotions become very intense, so one must be extremely cautious when ordering tests.

Banxia himself had just forgotten to consider this. Even with the most cooperative parents, if you perform a whole battery of tests without reaching a diagnosis, their reaction then would be even more terrifying.

To put it in popular terms, they placed so much trust in you, doing whatever you asked, and if you still can’t diagnose the issue and end up delaying the child’s treatment, it’s a form of betrayal to them.

"Do you think we’re making a mountain out of a molehill?" Chen Hongyang suddenly suggested. "What if it’s a problem with the nasal cavity?"

"The child’s ability to articulate is poor. What if the ’pain when breathing’ he mentioned actually refers to discomfort inside the nasal cavity rather than the respiratory tract? If there were a sinus infection, could it present with similar symptoms?"

"No, that’s not right. That shouldn’t be possible either. The child is only showing difficulty breathing and isn’t showing symptoms like a runny nose or head discomfort. Sinusitis would typically present with those symptoms."

Liu Banxia patted his shoulder. "Let’s wait for the CT results. I also lean more towards your initial judgment. Didn’t I encounter a young patient with nasal polyps before? That time even led to a bit of a joke. I feel this current young patient’s presentation is very different."

He knew Chen Hongyang was genuinely anxious, which was why he was acting a bit out of sorts. This was the pressure of working in pediatrics, a constant companion.

Liu Banxia wasn’t in a hurry to leave, as this young patient clearly needed urgent diagnosis and treatment. So he stayed to wait for the CT scans with Chen Hongyang.

"Teacher Liu, I’ve finished communicating with the patient’s family," Liu Yiqing found him and said. "They said they need to consider it carefully; this decision isn’t easy for them."

"Alright, don’t leave just yet then," Liu Banxia said casually. "We have a young patient here whose situation is a bit complex. Take a look at the case file yourself."

"Are you planning to focus on training her?" Chen Hongyang asked.

"They all need to be trained well," Liu Banxia said. "Soon, I’ll send them for rotations in the ICU and Pediatrics. What do you think?"

"That would be great," Chen Hongyang said. "I’m never worried about having too many helpers here."

"Especially us pediatricians, we often have to be skilled in both internal medicine and surgery. We really do need some outstanding people. The number of pediatric patients will only increase in the future, so we’ll need to supplement our staff here too."

"Let’s take it one step at a time," Liu Banxia said. "The support the hospital can provide right now is limited. The main principle is still to retain the outstanding interns."

"The current batch of interns in our Emergency Center were all handpicked by the Chief Director; their fundamentals are all solid. Who knows what the next batch will be like. We can’t expect to receive such high-caliber treatment every time."

"It’s tough. Who wants to be a pediatrician?" Chen Hongyang said with a bitter laugh.

Liu Banxia grimaced; that was indeed the case. Otherwise, there wouldn’t be a nationwide shortage of pediatricians. Working here isn’t just tiring; it’s more of an ordeal.

One has to take good care of the children and also deal with their parents and elders. The mental strain is far beyond just ’tiring.’

After waiting a while longer, the child’s CT scans were completed, and Chen Hongyang immediately pulled them up on the computer.

The CT scans were also very clear, with no signs of inflammation, which made the two of them even more worried.

Unless, as Liu Banxia had suggested, they ordered another abdominal CT to check for a carcinoid tumor. But the current indications weren’t strong enough. Would ordering another scan push the child’s parents past their breaking point?